Healthcare Provider Details

I. General information

NPI: 1750211603
Provider Name (Legal Business Name): JEREMY WOLFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 JACKSON ST
NEW VIENNA IA
52065-7750
US

IV. Provider business mailing address

2106 JACKSON ST
NEW VIENNA IA
52065-7750
US

V. Phone/Fax

Practice location:
  • Phone: 563-258-2936
  • Fax:
Mailing address:
  • Phone: 563-258-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138027
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: