Provider Demographics
NPI:1922210707
Name:WOLFE, TADE L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TADE
Middle Name:L
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 1:133A STAFF DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT. WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-664-7799
Mailing Address - Fax:
Practice Address - Street 1:133 A STAFF DRIVE
Practice Address - Street 2:
Practice Address - City:FT. WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-664-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist