Healthcare Provider Details

I. General information

NPI: 1427712314
Provider Name (Legal Business Name): JILIAN WOLFE CADC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 SW HIGHLAND AVE STE C
REDMOND OR
97756-2625
US

IV. Provider business mailing address

2214 NE HOLLIDAY AVE
BEND OR
97701-6033
US

V. Phone/Fax

Practice location:
  • Phone: 541-234-3081
  • Fax: 541-383-4935
Mailing address:
  • Phone: 541-630-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-21-1050
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: