Provider Demographics
NPI:1871668723
Name:WOLF, ANDREW J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:WOLF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20790 175TH STREET
Mailing Address - Street 2:
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732
Mailing Address - Country:US
Mailing Address - Phone:715-288-6926
Mailing Address - Fax:
Practice Address - Street 1:408 RED CEDAR ST
Practice Address - Street 2:AURORA COMMUNTIY COUNSELING EMPLOYEE SUPPORT & SERVICES
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751
Practice Address - Country:US
Practice Address - Phone:715-235-4696
Practice Address - Fax:715-235-3941
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6863 123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39715900Medicaid