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General NPI Number Information
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NPI Number | 1588713705
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Entity Type | Individual
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Provider Name | DENNIS KEITH WOLF LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12065 W JANESVILLE ROAD
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City | HALES CORNERS
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State | WI
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Zip | 53130
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Country | US
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Telephone | 414-425-2655
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Fax |
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Provider Business Mailing Address
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Address Line | 19090 STILL POINT TRAIL
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City | BROOKFIELD
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State | WI
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Zip | 53045
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Country | US
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Telephone | 262-786-0912
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2698123LCSW
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License Number State | WI
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