Provider Demographics
NPI:1720141062
Name:WOLF, MARGO EILEEN (RN, MSW, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:EILEEN
Last Name:WOLF
Suffix:
Gender:F
Credentials:RN, MSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:NEWMAN LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99025-0719
Mailing Address - Country:US
Mailing Address - Phone:509-226-2079
Mailing Address - Fax:509-838-4816
Practice Address - Street 1:7 S HOWARD ST STE 321
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3816
Practice Address - Country:US
Practice Address - Phone:509-838-4128
Practice Address - Fax:509-838-4816
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008762101YM0800X
WARC00040383104100000X
WARN00071741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA291865OtherVALUE OPTION
WA0041WOOtherASURIS NORTHWEST HEALTH
WA331448OtherMANAGED HEALTH NETWORK
WA91056495299201.A016OtherTRICARE