MEDICARE: SUSAN WOLF

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	39001681A	IN

General Provider Information

NPI Number	:	1346214475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WOLF

Provider Business Mailing Address
First Line	:	8180 CLEARVISTA PKWY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-5629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2040
Country	:	US
Telephone Number	:	317-621-7740
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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