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General NPI Number Information
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NPI Number | 1952776593
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Entity Type | Organization
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Legal Business Name | WOLF THERAPY LTD
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 4925 HIGHLAND AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3627
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Country | US
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Telephone | 708-670-5659
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Fax |
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Provider Business Mailing Address
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Address Line | 4925 HIGHLAND AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE MARIE LUCAS
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Credential | MS, CCC-SLP/L
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Telephone | 708-670-5659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 060011474
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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