Healthcare Provider Details

I. General information

NPI: 1619818366
Provider Name (Legal Business Name): JAYDE WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARK GLEN RD STE 155
SAINT LOUIS PARK MN
55416-4888
US

IV. Provider business mailing address

2285 UNIVERSITY AVE W UNIT 313B
SAINT PAUL MN
55114-1650
US

V. Phone/Fax

Practice location:
  • Phone: 612-284-4291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: