Provider Demographics
NPI:1881692986
Name:WOLFE, SUZETTE DELPHINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:DELPHINE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:DELPHINE
Other - Last Name:HARDESTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:374 SWOPE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24435-2815
Mailing Address - Country:US
Mailing Address - Phone:540-348-4149
Mailing Address - Fax:540-348-4149
Practice Address - Street 1:1105 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5010
Practice Address - Country:US
Practice Address - Phone:540-213-2164
Practice Address - Fax:540-213-2166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002395235Z00000X
WVSLP-0902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA092020OtherSOUTHERN HEALTH
VA260390OtherANTHEM