Provider Demographics
NPI:1023782539
Name:WOLFE, KIMBERLY A (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16020 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4206
Mailing Address - Country:US
Mailing Address - Phone:480-209-4483
Mailing Address - Fax:
Practice Address - Street 1:16020 S 23RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4206
Practice Address - Country:US
Practice Address - Phone:480-209-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist