Provider Demographics
NPI:1558565671
Name:WOLFE, GINGER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 GREYMOOR PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7712
Mailing Address - Country:US
Mailing Address - Phone:079-854-7777
Mailing Address - Fax:
Practice Address - Street 1:2400 N CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3105
Practice Address - Country:US
Practice Address - Phone:817-949-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102129OtherHUMANA
TX111408402Medicaid
TX102129OtherTX LICENSE #