1942282272 NPI number — DR. DORA MARIE JOHNS WOLFE PSY. D.

Table of content: DR. DORA MARIE JOHNS WOLFE PSY. D. (NPI 1942282272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942282272 NPI number — DR. DORA MARIE JOHNS WOLFE PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNS WOLFE
Provider First Name:
DORA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNS
Provider Other First Name:
DORA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942282272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
683 JULI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LENOX
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60451-1269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-953-0941
Provider Business Mailing Address Fax Number:
815-462-3837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 ALANA DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LENOX
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-279-0467
Provider Business Practice Location Address Fax Number:
815-462-3837
Provider Enumeration Date:
11/14/2005

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: 103TC0700X , with the licence number:  20041746A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , 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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