Healthcare Provider Details

I. General information

NPI: 1174791446
Provider Name (Legal Business Name): LAURA WULFF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-345-7296
  • Fax: 904-345-7255
Mailing address:
  • Phone: 904-345-7296
  • Fax: 904-345-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: