Healthcare Provider Details

I. General information

NPI: 1063618064
Provider Name (Legal Business Name): GINA KAY WOLFF M.A CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N LINDEN RD
MANSFIELD OH
44906-2616
US

IV. Provider business mailing address

1545 TOWNSHIP ROAD 166
MARENGO OH
43334-9561
US

V. Phone/Fax

Practice location:
  • Phone: 419-525-6369
  • Fax:
Mailing address:
  • Phone: 614-496-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-5363
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: