Provider Demographics
NPI:1467646356
Name:WULF, NELDA JEAN CAROL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NELDA JEAN
Middle Name:CAROL
Last Name:WULF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:C
Other - Last Name:WULF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1339 31ST STREET CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1206
Mailing Address - Country:US
Mailing Address - Phone:719-659-6097
Mailing Address - Fax:719-578-1759
Practice Address - Street 1:1339 31ST STREET CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1206
Practice Address - Country:US
Practice Address - Phone:719-659-6097
Practice Address - Fax:719-578-8589
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9895261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC88576Medicare PIN