Healthcare Provider Details

I. General information

NPI: 1669360350
Provider Name (Legal Business Name): WENDE WOLFE LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TWIN CREEKS XING STE A
CENTRAL POINT OR
97502-8661
US

IV. Provider business mailing address

PO BOX 5016
CENTRAL POINT OR
97502-0042
US

V. Phone/Fax

Practice location:
  • Phone: 504-372-0939
  • Fax: 541-871-7143
Mailing address:
  • Phone: 504-372-0939
  • Fax: 541-871-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDE WOLFE
Title or Position: OWNER
Credential:
Phone: 504-372-0939