Provider Demographics
NPI:1386327278
Name:WOLF, MYKALA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:MYKALA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 N 25TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-2951
Mailing Address - Country:US
Mailing Address - Phone:618-554-4970
Mailing Address - Fax:
Practice Address - Street 1:437 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1726
Practice Address - Country:US
Practice Address - Phone:217-466-6718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24200720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist