1376717652 NPI number — MS. CONSUELO GODINEZ WOLF LCSW

Table of content: MS. CONSUELO GODINEZ WOLF LCSW (NPI 1376717652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376717652 NPI number — MS. CONSUELO GODINEZ WOLF LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
CONSUELO
Provider Middle Name:
GODINEZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLF
Provider Other First Name:
CONNIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376717652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 N MARINE DRIVE
Provider Second Line Business Mailing Address:
THE SALVATION ARMY FAMILY AND COMMUNITY SERVICES
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-275-6233
Provider Business Mailing Address Fax Number:
773-275-6288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 N MARINE DRIVE
Provider Second Line Business Practice Location Address:
THE SALVATION ARMY FAMILY AND COMMUNITY SERVICES
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-275-6233
Provider Business Practice Location Address Fax Number:
773-275-6288
Provider Enumeration Date:
04/17/2008

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 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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