MEDICARE: JENDEL WOLFE PLPC

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	101YP2500X	Professional Counselor	2022045285	MO

General Provider Information

NPI Number	:	1164292330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENDEL WOLFE PLPC

Provider Business Mailing Address
First Line	:	15424 LAWRENCE 1110
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-9311
Country	:	US
Telephone Number	:	417-669-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	15424 LAWRENCE 1110
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-9311
Country	:	US
Telephone Number	:	176-696-6924
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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