Provider Demographics
NPI:1376091231
Name:WOLFE, KINLEY MARY MICHELE (MSC, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KINLEY
Middle Name:MARY MICHELE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MSC, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 5020
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5020
Mailing Address - Country:US
Mailing Address - Phone:701-857-5105
Mailing Address - Fax:701-857-5646
Practice Address - Street 1:407 3RD ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4470
Practice Address - Country:US
Practice Address - Phone:701-857-5514
Practice Address - Fax:701-857-2604
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist