Provider Demographics
NPI:1528155298
Name:WOLF, STACY C (AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:C
Last Name:WOLF
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4206
Mailing Address - Country:US
Mailing Address - Phone:319-260-2155
Mailing Address - Fax:319-260-2289
Practice Address - Street 1:1820 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-4206
Practice Address - Country:US
Practice Address - Phone:319-260-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00436231H00000X
IA00711237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0181040Medicaid