Provider Demographics
NPI:1558522185
Name:WOLF, STEPHANIE JO
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
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:RR 2 BOX 534A
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-9726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 LAKEMONT PARK BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5947
Practice Address - Country:US
Practice Address - Phone:814-946-0261
Practice Address - Fax:814-569-1189
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor