Provider Demographics
NPI:1558633024
Name:WOLFE, BROOKS GIBSON
Entity Type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:GIBSON
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6129
Mailing Address - Country:US
Mailing Address - Phone:501-324-9512
Mailing Address - Fax:501-324-9822
Practice Address - Street 1:2400 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6129
Practice Address - Country:US
Practice Address - Phone:501-324-9512
Practice Address - Fax:501-324-9822
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR128231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist