Provider Demographics
NPI:1952658098
Name:WOLFE, DIANE GAIL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:GAIL
Last Name:WOLFE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 OLD BRUCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3889
Mailing Address - Country:US
Mailing Address - Phone:812-886-4677
Mailing Address - Fax:812-886-4678
Practice Address - Street 1:1095 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3961
Practice Address - Country:US
Practice Address - Phone:618-656-1081
Practice Address - Fax:618-656-7083
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist