1386652865 NPI number — MS. KERRY J WOLFE LPC

Table of content: MS. KERRY J WOLFE LPC (NPI 1386652865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386652865 NPI number — MS. KERRY J WOLFE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
KERRY
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JUNG
Provider Other First Name:
KERRY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386652865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1046 EAST ST APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT ATKINSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53538-2642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-723-1639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
WHITEWATER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53190-1995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-728-4416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2006

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: 101YP2500X , with the licence number:  3517125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39184249628 . This is a "UNITY HEALTH INS WATERTOW" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 13798 . This is a "DEAN HEALTH INSU" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 209292 . This is a "PHYSICIANS PLUS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 40982700H0 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 353740 . This is a "MHN INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39184249629 . This is a "UNITY INSURANCE LAKE MILL" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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