Provider Demographics
NPI:1891310165
Name:EXERJIAN, INGRID WOLFER (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:WOLFER
Last Name:EXERJIAN
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 1:1844 MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2208
Mailing Address - Country:US
Mailing Address - Phone:619-218-4389
Mailing Address - Fax:
Practice Address - Street 1:1844 MALDEN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2208
Practice Address - Country:US
Practice Address - Phone:619-218-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP4166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist