MEDICARE: MARY K WOLF LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10287	MN
2	1041C0700X	Clinical Social Worker	8260	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154308419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY K WOLF LCSW

Provider Business Mailing Address
First Line	:	32 S MAIN ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3941
Country	:	US
Telephone Number	:	608-618-5560
Fax Number	:	855-277-9589

Provider Business Practice Location Address
First Line	:	32 S MAIN ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3941
Country	:	US
Telephone Number	:	608-618-5560
Fax Number	:	855-277-9589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	11/03/2023

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