Provider Demographics
NPI:1538340450
Name:WOLFE, KRYSTAL K (BC HIS)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:K
Last Name:WOLFE
Suffix:
Gender:F
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:3900 HALL AVE SUITE D
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0534
Mailing Address - Country:US
Mailing Address - Phone:715-732-5300
Mailing Address - Fax:
Practice Address - Street 1:3900 HALL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-0534
Practice Address - Country:US
Practice Address - Phone:715-732-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42835000Medicaid