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NPI Code Detail

MEDICARE: JACE A WOLFE PHD

MEDICARE: JACE A WOLFE PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist281OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063584100
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACE A WOLFE PHD
Provider Business Mailing Address
First Line : 11500 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-4625
Country : US
Telephone Number : 405-548-4300
Fax Number :
Provider Business Practice Location Address
First Line : 11500 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-4625
Country : US
Telephone Number : 405-548-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 10/23/2017

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Directions to “ JACE A WOLFE PHD” Practice Location

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