Provider Demographics
NPI:1659365468
Name:WOLFE, JENNELL LYNN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNELL
Middle Name:LYNN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:JENNELL
Other - Middle Name:LYNN
Other - Last Name:HOAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1590 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1721
Mailing Address - Country:US
Mailing Address - Phone:412-779-2297
Mailing Address - Fax:
Practice Address - Street 1:949 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2106
Practice Address - Country:US
Practice Address - Phone:412-364-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0033012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer