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General NPI Number Information
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NPI Number | 1992717813
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Entity Type | Individual
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Provider Name | JACQUELINE LEE WOLFE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 134 W LAKE ST
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1020
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Country | US
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Telephone | 630-740-3382
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Fax |
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Provider Business Mailing Address
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Address Line | 33 E ARMITAGE AVE
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City | ADDISON
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State | IL
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Zip | 60101-4853
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Country | US
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Telephone | 630-740-3382
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Fax | 630-530-2569
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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 | 149007004
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License Number State | IL
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