Healthcare Provider Details

I. General information

NPI: 1952498297
Provider Name (Legal Business Name): VIRGINIA WOLFE MA, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA WOLFE COTHRAN MA,LP

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SIBLEY ST SUITE 500
SAINT PAUL MN
55101-1941
US

IV. Provider business mailing address

400 SIBLEY ST SUITE 500
SAINT PAUL MN
55101-1941
US

V. Phone/Fax

Practice location:
  • Phone: 651-256-1242
  • Fax: 651-291-7378
Mailing address:
  • Phone: 651-256-1242
  • Fax: 651-291-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3030
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3030
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: