Basic Information
| Provider Information | |||||||||
| NPI: | 1013138452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CMT, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457 ANIMAS VIEW DR | ||||||||
| Address2: | UNIT 19 | ||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813019003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707641790 | ||||||||
| FaxNumber: | 9703757927 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 COUNTY ROAD 250 UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813018848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707691967 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW00001169 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.