Provider Demographics
NPI:1558464610
Name:WOLFSON, KAREN GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:GAIL
Last Name:WOLFSON
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:PO BOX 2713
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61825-2713
Mailing Address - Country:US
Mailing Address - Phone:217-493-8045
Mailing Address - Fax:217-244-8961
Practice Address - Street 1:1401 REGENCY DR E
Practice Address - Street 2:SUITE 2
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9312
Practice Address - Country:US
Practice Address - Phone:217-493-8045
Practice Address - Fax:217-244-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical