MEDICARE: RYAN D WOLF RCSWI

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	101Y00000X	Counselor	ISW18480	FL

General Provider Information

NPI Number	:	1528899168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN D WOLF RCSWI

Provider Business Mailing Address
First Line	:	6232 FOREST BAY AVE
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-9799
Country	:	US
Telephone Number	:	850-860-2177
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 FOREST BAY AVE
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-9799
Country	:	US
Telephone Number	:	850-860-2177
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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