Healthcare Provider Details

I. General information

NPI: 1952776593
Provider Name (Legal Business Name): WOLF THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 HIGHLAND AVE
DOWNERS GROVE IL
60515-3627
US

IV. Provider business mailing address

4925 HIGHLAND AVE
DOWNERS GROVE IL
60515-3627
US

V. Phone/Fax

Practice location:
  • Phone: 708-670-5659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number060011474
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MARIE LUCAS
Title or Position: OWNER
Credential: MS, CCC-SLP/L
Phone: 708-670-5659