Provider Demographics
NPI:1164855201
Name:WULF, KENNETH DENTON
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DENTON
Last Name:WULF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 S TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4923
Mailing Address - Country:US
Mailing Address - Phone:512-810-3191
Mailing Address - Fax:
Practice Address - Street 1:4601 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5441
Practice Address - Country:US
Practice Address - Phone:501-686-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical