Provider Demographics
NPI:1760992754
Name:WOLF, REBECCA MICHELE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MICHELE
Last Name:WOLF
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 1:250 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3503
Mailing Address - Country:US
Mailing Address - Phone:407-380-3466
Mailing Address - Fax:
Practice Address - Street 1:222 NEIGHBORHOOD MARKET RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3525
Practice Address - Country:US
Practice Address - Phone:407-403-5822
Practice Address - Fax:407-403-5818
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist