Healthcare Provider Details

I. General information

NPI: 1467646356
Provider Name (Legal Business Name): NELDA JEAN CAROL WULF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEAN C. WULF LCSW

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 31ST STREET CIR
COLORADO SPRINGS CO
80904-1206
US

IV. Provider business mailing address

1339 31ST STREET CIR
COLORADO SPRINGS CO
80904-1206
US

V. Phone/Fax

Practice location:
  • Phone: 719-659-6097
  • Fax: 719-578-8589
Mailing address:
  • Phone: 719-659-6097
  • Fax: 719-578-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989526
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: