MEDICARE: OLIVIA MCKAY WOLFF-HERDA MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023897105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MCKAY WOLFF-HERDA MA

Provider Business Mailing Address
First Line	:	13750 CROSSTOWN DR NW STE 10
Second Line	:
City	:	ANDOVER
State	:	MN
Zip	:	55304-5853
Country	:	US
Telephone Number	:	763-317-8255
Fax Number	:	855-913-2522

Provider Business Practice Location Address
First Line	:	13750 CROSSTOWN DR NW STE 10
Second Line	:
City	:	ANDOVER
State	:	MN
Zip	:	55304-5853
Country	:	US
Telephone Number	:	763-317-8255
Fax Number	:	855-913-2522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	04/13/2026

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