MEDICARE: MR. MATTHEW LAWSON WOLFF

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
1	2355S0801X	Speech-Language Assistant	15-017	AR
2	106S00000X	Behavior Technician		AR

General Provider Information

NPI Number	:	1205207040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW LAWSON WOLFF

Provider Business Mailing Address
First Line	:	47 LINDULAKE DR
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023-9325
Country	:	US
Telephone Number	:	501-628-1837
Fax Number	:

Provider Business Practice Location Address
First Line	:	5307 JFK BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6703
Country	:	US
Telephone Number	:	501-392-6201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	09/04/2019

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