Provider Demographics
NPI:1679625271
Name:WOLFORD, MARTI ANN (MA CC SLP)
Entity type:Individual
Prefix:
First Name:MARTI
Middle Name:ANN
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:MA CC SLP
Other - Prefix:
Other - First Name:MARTI
Other - Middle Name:ANN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CC SLP
Mailing Address - Street 1:1 S CASS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1893
Mailing Address - Country:US
Mailing Address - Phone:630-353-9158
Mailing Address - Fax:
Practice Address - Street 1:1 S CASS AVE STE 202
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1893
Practice Address - Country:US
Practice Address - Phone:630-353-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146 006338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist