Provider Demographics
NPI:1053745398
Name:WOLFE, MARLA FAITH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:FAITH
Last Name:WOLFE
Suffix:
Gender:F
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 1:21 TREMONT TER
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3217
Mailing Address - Country:US
Mailing Address - Phone:973-650-6584
Mailing Address - Fax:
Practice Address - Street 1:57 UNION PL
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2568
Practice Address - Country:US
Practice Address - Phone:908-273-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00744600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist