Healthcare Provider Details

I. General information

NPI: 1558514547
Provider Name (Legal Business Name): DEANNA S WOLFGONG MMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 GRANDVIEW RD
OIL CITY PA
16301-2077
US

IV. Provider business mailing address

815 GRANDVIEW RD
OIL CITY PA
16301-2077
US

V. Phone/Fax

Practice location:
  • Phone: 814-676-5614
  • Fax:
Mailing address:
  • Phone: 814-676-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number08825
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: