Individual
MR. WOLLY JEFFERSON JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1224 BEACON ST APT 3, EAST CHICAGO, IN 46312-4213
(508) 897-9171
Mailing address
1224 BEACON ST APT 3, EAST CHICAGO, IN 46312-4213
(508) 897-9171
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
29002063A
IN
Other
Enumeration date
05/17/2023
Last updated
05/17/2023
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