Provider Demographics
NPI:1407203003
Name:WOLTZEN, CAROL (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:WOLTZEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WEST AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1374
Mailing Address - Country:US
Mailing Address - Phone:605-271-0218
Mailing Address - Fax:605-271-0220
Practice Address - Street 1:1000 N WEST AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1374
Practice Address - Country:US
Practice Address - Phone:605-271-0218
Practice Address - Fax:605-271-0220
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD228-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist