Provider Demographics
NPI:1396372918
Name:WOOLFREY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WOOLFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 JOHNNY APPLESEED LN
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4574
Mailing Address - Country:US
Mailing Address - Phone:978-549-4211
Mailing Address - Fax:
Practice Address - Street 1:435 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4397
Practice Address - Country:US
Practice Address - Phone:978-466-7407
Practice Address - Fax:978-466-7407
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA474237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1598891855Medicaid