Provider Demographics
NPI:1003642653
Name:WOLFE, KRISTINE DIANE (M A CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:DIANE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-9316
Mailing Address - Country:US
Mailing Address - Phone:304-633-7281
Mailing Address - Fax:
Practice Address - Street 1:56 REGAL OAKS
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9639
Practice Address - Country:US
Practice Address - Phone:304-633-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist