Provider Demographics
NPI:1477668127
Name:WOOLLEY, FRANK (LCSW)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:WOOLLEY
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 1:2100 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6366
Mailing Address - Country:US
Mailing Address - Phone:309-797-2900
Mailing Address - Fax:309-797-2147
Practice Address - Street 1:2100 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6366
Practice Address - Country:US
Practice Address - Phone:309-797-2900
Practice Address - Fax:309-797-2147
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL83529Medicare UPIN