Healthcare Provider Details

I. General information

NPI: 1942065974
Provider Name (Legal Business Name): MRS. VICKI LYN WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 E MAIN ST
MONTROSE CO
81401-3840
US

IV. Provider business mailing address

3801 GRAND MESA DR
MONTROSE CO
81403-7115
US

V. Phone/Fax

Practice location:
  • Phone: 970-765-0550
  • Fax:
Mailing address:
  • Phone: 303-641-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: