Provider Demographics
NPI:1245939750
Name:WOLFE, AJA SUE (MA)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:SUE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AJA
Other - Middle Name:SUE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:169 MAINZER ST
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1531
Mailing Address - Country:US
Mailing Address - Phone:612-223-2782
Mailing Address - Fax:
Practice Address - Street 1:169 MAINZER ST
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1531
Practice Address - Country:US
Practice Address - Phone:612-223-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health