Provider Demographics
NPI:1265823009
Name:MANCINIK, JESSICA WOLFF (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:WOLFF
Last Name:MANCINIK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MAE
Other - Last Name:WOLFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:DEPT OF SPEECH PATHOLOGY & AUDIOLOGY BOX 3887-DUMC
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:813-695-1794
Mailing Address - Fax:
Practice Address - Street 1:40 DUKE MEDICINE CIRCLE DUKE UNIVERSITY & HEALTH SYSTEM
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-8399
Practice Address - Country:US
Practice Address - Phone:919-684-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13296235Z00000X
NC13270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010163500Medicaid