Kim Phan Wolff, M.S., BCBA, COBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

COBA.91 Issued in OH

Practice address

3505 Embassy Pkwy
Fairlawn, OH 44333-8405

Phone

(330) 271-6107

Fax

(330) 706-4705

NPI assigned

Dec 7, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kim Phan Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wolff & Phan Autism Center, LLC

  • Behavior Analyst
  • Fairlawn, OH
  • NPI 1750979233
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647561600000",
    "number": "1376871194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 EMBASSY PKWY STE 100",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443338403",
            "telephone_number": "302-716-1073",
            "fax_number": "330-706-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 EMBASSY PKWY",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443338405",
            "telephone_number": "330-271-6107",
            "fax_number": "330-706-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFF",
        "first_name": "KIM",
        "middle_name": "PHAN",
        "credential": "M.S., BCBA, COBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-07",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "OH",
            "license": "COBA.91",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA CERTIFICATE",
            "identifier": "1-09-6600",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KWOLFF@WPAUTISMCENTER.COM",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PROFESSIONAL",
            "address_1": "3505 Embassy Pkwy",
            "city": "Fairlawn",
            "state": "OH",
            "country_code": "US",
            "postal_code": "443338405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "PHAN",
            "credential": "M.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marissa Woitas
• Kaitlin Wojno, BCBA
• Theresa Wolf, BCABA
• Jenni Wolfenbarger, PTA
• Wolff & Phan Autism Center, LLC
• Jennifer Lynn Wolverton, M.S., OTR/L
• Vannesa Woodall-Powell
• Kayla Woodall
• Allison Woods
• Nathan J. Woollard, PT

• Behavior Analyst in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Behavior Analyst in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.