Provider Demographics
NPI:1912202706
Name:WOLFE, SUSAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WOLFE
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 1:8311 HAMBLETONIAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1312
Mailing Address - Country:US
Mailing Address - Phone:513-530-0031
Mailing Address - Fax:
Practice Address - Street 1:8311 HAMBLETONIAN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1312
Practice Address - Country:US
Practice Address - Phone:513-530-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 1638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist