Provider Demographics
NPI:1346698586
Name:WOLF, DIANE CAROL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:WOLF
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CUMING STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131
Mailing Address - Country:US
Mailing Address - Phone:402-557-4600
Mailing Address - Fax:402-557-4609
Practice Address - Street 1:5105 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3546
Practice Address - Country:US
Practice Address - Phone:402-557-4600
Practice Address - Fax:402-557-4609
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist