Provider Demographics
NPI:1295023190
Name:WOLFE, JILL MARIA (SLPA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIA
Last Name:WOLFE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIA
Other - Last Name:BIDDLECOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4542 E INVERNESS AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4619
Mailing Address - Country:US
Mailing Address - Phone:480-926-6309
Mailing Address - Fax:480-926-1365
Practice Address - Street 1:4542 E INVERNESS AVE STE C1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4619
Practice Address - Country:US
Practice Address - Phone:480-926-6309
Practice Address - Fax:480-926-1365
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA7223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist