Provider Demographics
NPI:1346766946
Name:WOLF, SHELBY MARIE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3519
Mailing Address - Country:US
Mailing Address - Phone:507-345-7012
Mailing Address - Fax:507-388-6937
Practice Address - Street 1:103 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3519
Practice Address - Country:US
Practice Address - Phone:507-345-7012
Practice Address - Fax:507-388-6937
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist