Provider Demographics
NPI:1386651776
Name:WOOLCOCK, WENDY (SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WOOLCOCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17859-9162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 GLENN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1200
Practice Address - Country:US
Practice Address - Phone:570-387-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000034L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist