Healthcare Provider Details

I. General information

NPI: 1346766946
Provider Name (Legal Business Name): SHELBY MARIE WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E WALNUT ST STE 260
MANKATO MN
56001-1103
US

IV. Provider business mailing address

124 E WALNUT ST STE 260
MANKATO MN
56001-1103
US

V. Phone/Fax

Practice location:
  • Phone: 507-461-8061
  • Fax:
Mailing address:
  • Phone: 507-461-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP6440
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: