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General NPI Number Information
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NPI Number | 1508206590
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Entity Type | Individual
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Provider Name | JILLIAN WOLF PH.D. - HSP
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Gender | Female
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 433 NISSAN DRIVE STE. 303
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City | SMYRNA
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State | TN
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Zip | 37167-4360
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Country | US
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Telephone | 615-972-6644
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Fax | 615-624-9114
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Provider Business Mailing Address
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Address Line | 433 NISSAN DRIVE STE. 303
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City | SMYRNA
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State | TN
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Zip | 37167-4360
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Country | US
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Telephone | 615-972-6644
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Fax | 615-624-9114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3103
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | TN3103
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License Number State | TN
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