Provider Demographics
NPI:1821454703
Name:WOLF, DORIS (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
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 1:222 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3312
Mailing Address - Country:US
Mailing Address - Phone:407-657-2323
Mailing Address - Fax:
Practice Address - Street 1:222 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3312
Practice Address - Country:US
Practice Address - Phone:407-657-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist