1477710580 NPI number — MRS. ERIN JEAN WOLFF LMFT

Table of content: MRS. ERIN JEAN WOLFF LMFT (NPI 1477710580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477710580 NPI number — MRS. ERIN JEAN WOLFF LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFF
Provider First Name:
ERIN
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KITUMBA
Provider Other First Name:
ERIN
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477710580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 71093
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97475-0182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-357-8864
Provider Business Mailing Address Fax Number:
541-225-5935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1126 GATEWAY LOOP
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97477-7723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-357-8864
Provider Business Practice Location Address Fax Number:
541-225-5935
Provider Enumeration Date:
05/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: T1112 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500660855 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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