Provider Demographics
NPI:1689286296
Name:WOLFE, DAWN MARIA (MA)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIA
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 W RTE 17
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-7964
Mailing Address - Country:US
Mailing Address - Phone:815-474-4265
Mailing Address - Fax:
Practice Address - Street 1:295 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1581
Practice Address - Country:US
Practice Address - Phone:815-515-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional