Provider Demographics
NPI:1548824642
Name:WOLFORD, DENEESE MARIE (SUDP)
Entity type:Individual
Prefix:
First Name:DENEESE
Middle Name:MARIE
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:DENEESE
Other - Middle Name:MARIE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUDPT
Mailing Address - Street 1:910 W BOONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5029
Mailing Address - Country:US
Mailing Address - Phone:509-325-7232
Mailing Address - Fax:
Practice Address - Street 1:910 W BOONE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5029
Practice Address - Country:US
Practice Address - Phone:509-325-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60934859390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program