MEDICARE: A.R.WOLFE, PH.D. AND ASSOCIATES

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	103T00000X	Psychologist	071003493	IL

General Provider Information

NPI Number	:	1063699155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.R.WOLFE, PH.D. AND ASSOCIATES

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	#304
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-593-8027
Fax Number	:	312-664-6389

Provider Business Practice Location Address
First Line	:	2518 N LINCOLN AVE
Second Line	:	#204
City	:	CHICAGO
State	:	IL
Zip	:	60614-2782
Country	:	US
Telephone Number	:	312-593-8027
Fax Number	:	312-664-6389

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	ANNE R. WOLFE
Credential	:	PH.D.
Telephone Number	:	312-593-8027

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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