Provider Demographics
NPI:1265160824
Name:WOLF, MYKEL MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:MYKEL
Middle Name:MARIE
Last Name:WOLF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 FICUS WAY APT 106
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-4848
Mailing Address - Country:US
Mailing Address - Phone:831-206-8520
Mailing Address - Fax:
Practice Address - Street 1:5250 RALSTON ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7318
Practice Address - Country:US
Practice Address - Phone:805-339-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12974562-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist