Provider Demographics
NPI:1912123076
Name:WOLFE, BASIL N JR (AUD)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:N
Last Name:WOLFE
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 DAWN PL
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7251
Mailing Address - Country:US
Mailing Address - Phone:440-796-4575
Mailing Address - Fax:440-354-3211
Practice Address - Street 1:7324 DAWN PL
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7251
Practice Address - Country:US
Practice Address - Phone:440-796-4575
Practice Address - Fax:440-354-3211
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00073231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist