Provider Demographics
NPI:1497924914
Name:WOLF, JANIS L (LCSW)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:L
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LAKELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4610
Mailing Address - Country:US
Mailing Address - Phone:217-238-3370
Mailing Address - Fax:217-258-3379
Practice Address - Street 1:501 LAKE LAND BLVD
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-5283
Practice Address - Country:US
Practice Address - Phone:217-258-3370
Practice Address - Fax:217-258-3379
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490070801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical