Wolf, Brian A

Wolf, Brian A is an individual health care provider with primary practice located at 2108 63Rd St , Kenosha WI 53143-4454. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Wolf, Brian A can be contacted via phone (262) 652-2406.

Contact Information

Primary practice address
2108 63Rd St Kenosha WI 53143-4454
Phone: (262) 652-2406
Fax: (262) 652-2408
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1039-057 Wisconsin
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 12126 Wisconsin

Profile Details

NPI number 1609982040
LBN Legal business name Wolf, Brian A
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 21st, 2006
Last updated Jun 30th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609982040 NPPES
Wisconsin MEDICAID 39046000

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