Provider Demographics
NPI:1023276813
Name:WOLFE, JACKIE SUE (CRT)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:SUE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
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Mailing Address - Street 1:15640 N 7TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3512
Mailing Address - Country:US
Mailing Address - Phone:602-439-3800
Mailing Address - Fax:602-439-3802
Practice Address - Street 1:15640 N 7TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3512
Practice Address - Country:US
Practice Address - Phone:602-439-3800
Practice Address - Fax:602-439-3802
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6346227800000X, 2278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6346OtherAZ STATE BOARD OF RESPIRATORY CARE EXAMINERS