Healthcare Provider Details

I. General information

NPI: 1255877791
Provider Name (Legal Business Name): LEA WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53585 NOKOMIS RD
ASHLAND WI
54806-4272
US

IV. Provider business mailing address

53585 NOKOMIS RD
ASHLAND WI
54806-4272
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-7133
  • Fax:
Mailing address:
  • Phone: 715-682-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134867
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberW410-5337-8912-04
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: