1023264686 NPI number — MRS. MEGAN RENEE BRANDT WOLF MSW, LCSW

Table of content: MRS. MEGAN RENEE BRANDT WOLF MSW, LCSW (NPI 1023264686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023264686 NPI number — MRS. MEGAN RENEE BRANDT WOLF MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
MEGAN
Provider Middle Name:
RENEE BRANDT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRANDT
Provider Other First Name:
MEGAN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023264686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 W JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122-4062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-596-6890
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 W JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-4062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-596-6890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2008

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: 1041C0700X , with the licence number:  2005000627 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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