Provider Demographics
NPI:1669257549
Name:WOLFLA, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WOLFLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N NEW JERSEY ST APT 423
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2889
Mailing Address - Country:US
Mailing Address - Phone:317-373-3203
Mailing Address - Fax:
Practice Address - Street 1:25 N NEW JERSEY ST APT 423
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2889
Practice Address - Country:US
Practice Address - Phone:317-373-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical