Provider Demographics
NPI:1841569746
Name:WOLF, LACEY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:ANN
Last Name:WOLF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:LACEY
Other - Middle Name:ANN
Other - Last Name:TIEFENTHALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1915 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8768
Mailing Address - Country:US
Mailing Address - Phone:515-232-7220
Mailing Address - Fax:
Practice Address - Street 1:1915 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8768
Practice Address - Country:US
Practice Address - Phone:515-232-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist