Provider Demographics
NPI:1013238476
Name:WOLFSLAU, DANA LEIGH (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LEIGH
Last Name:WOLFSLAU
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LEIGH
Other - Last Name:STUBBLEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:261 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:AVISTON
Mailing Address - State:IL
Mailing Address - Zip Code:62216-3582
Mailing Address - Country:US
Mailing Address - Phone:618-228-7102
Mailing Address - Fax:
Practice Address - Street 1:261 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:AVISTON
Practice Address - State:IL
Practice Address - Zip Code:62216-3582
Practice Address - Country:US
Practice Address - Phone:618-228-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist