Provider Demographics
NPI:1942282272
Name:JOHNS WOLFE, DORA MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:MARIE
Last Name:JOHNS WOLFE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:DORA
Other - Middle Name:MARIE
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:683 JULI DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1269
Mailing Address - Country:US
Mailing Address - Phone:815-953-0941
Mailing Address - Fax:815-462-3837
Practice Address - Street 1:339 ALANA DR.
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-279-0467
Practice Address - Fax:815-462-3837
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041746A103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical