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NPI Code Detail

MEDICARE: CAMILLE SUZANNE WOLFE

MEDICARE: CAMILLE SUZANNE WOLFE
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
1106S00000XBehavior TechnicianRBT-25-406316MO

General Provider Information

NPI Number : 1295691764
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLE SUZANNE WOLFE
Provider Business Mailing Address
First Line : 1806B W WASHITA ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-2260
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 840 E PRIMROSE ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5254
Country : US
Telephone Number : 417-771-9414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2025
Last Update Date : 12/29/2025

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Directions to “ CAMILLE SUZANNE WOLFE ” Practice Location

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