Provider Demographics
NPI:1215605894
Name:WOLF, SARAH (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 KINGFISH DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-9352
Mailing Address - Country:US
Mailing Address - Phone:254-749-3349
Mailing Address - Fax:
Practice Address - Street 1:268 KINGFISH DR
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-9352
Practice Address - Country:US
Practice Address - Phone:254-749-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14319042235Z00000X
TX114496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist