Healthcare Provider Details

I. General information

NPI: 1740113570
Provider Name (Legal Business Name): MARIA WOOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ORCHARD AVE
ARROYO GRANDE CA
93420-4000
US

IV. Provider business mailing address

749 HIGHLAND WAY
GROVER BEACH CA
93433-3032
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-3000
  • Fax:
Mailing address:
  • Phone: 805-550-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: