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NPI Code Detail

MEDICARE: SHEWOLFE, LLC

MEDICARE: SHEWOLFE, LLC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1386253441
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHEWOLFE, LLC
Provider Business Mailing Address
First Line : 3709 E BROCKBANK DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-3907
Country : US
Telephone Number : 801-505-9237
Fax Number :
Provider Business Practice Location Address
First Line : 4578 S HIGHLAND DR STE 320
Second Line :
City : MILLCREEK
State : UT
Zip : 84117-4214
Country : US
Telephone Number : 801-505-9237
Fax Number :
Authorized Official
Title or Position : OWNER
Name : NIKI WOLFE
Credential : CMHC
Telephone Number : 801-505-9237
Provider Enumeration Date : 07/24/2020
Last Update Date : 07/24/2020

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