Provider Demographics
NPI:1760470603
Name:WOLF, CHERYL A (LCPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK PL
Mailing Address - Street 2:SUITE #24
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1885
Mailing Address - Country:US
Mailing Address - Phone:815-932-3395
Mailing Address - Fax:815-933-0154
Practice Address - Street 1:201 PARK PL
Practice Address - Street 2:SUITE #24
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1885
Practice Address - Country:US
Practice Address - Phone:815-932-3395
Practice Address - Fax:815-933-0154
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2088369OtherCIGNA PROVIDER NUMBER
IL04632009OtherBC/BS PROVIDER NUMBER
IL234124OtherCOMPSYCH
IL531590OtherVALUE OPTIONS
IL7761273OtherAETNA PROVIDER NUMBER