Provider Demographics
NPI:1982774980
Name:WOLFE, PETER F (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:F
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MEETING PL
Mailing Address - Street 2:UNIT 214
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-5907
Mailing Address - Country:US
Mailing Address - Phone:407-780-0080
Mailing Address - Fax:
Practice Address - Street 1:5800 GOLF CLUB PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4800
Practice Address - Country:US
Practice Address - Phone:407-299-5553
Practice Address - Fax:407-299-5520
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004973235Z00000X
FLSA9039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000907497BMedicaid
GA10065231OtherAMERIGROUP
GA312242OtherWELLCARE
FL892334500Medicaid