=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619062478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOLZ HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8714 DAY RD
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62902-0427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-559-3319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8714 DAY RD
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62902-0427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-559-3319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORP. PRESIDENT
-----------------------------------------------------
Name | MRS. ALYSON G. WOLZ
-----------------------------------------------------
Credential | FP-APRN,PMHCNS, BC
-----------------------------------------------------
Telephone | 618-559-3319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 209-000115
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------