=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902069818
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WOLFF MA, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2008
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W 2ND ST
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55802-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-728-4491
-----------------------------------------------------
Fax | 218-302-8698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 EAST 1ST STREET
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-728-4491
-----------------------------------------------------
Fax | 218-302-8698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1840
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------