Provider Demographics
NPI:1437404670
Name:WOLF, LEAH NICOLE (LMP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:NICOLE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 E 2ND AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0662
Mailing Address - Country:US
Mailing Address - Phone:509-362-3937
Mailing Address - Fax:
Practice Address - Street 1:6813 E 2ND AVE APT 6
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0662
Practice Address - Country:US
Practice Address - Phone:509-362-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60285866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist