Provider Demographics
NPI:1134535057
Name:WOLFF, MIRANDA (SLPD CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:SLPD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 AMSTEL WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5818
Mailing Address - Country:US
Mailing Address - Phone:267-566-1906
Mailing Address - Fax:
Practice Address - Street 1:1324 AMSTEL WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5818
Practice Address - Country:US
Practice Address - Phone:267-566-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL01186235Z00000X
PASL011864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist