Provider Demographics
NPI:1740043447
Name:WOLFE, KENDALL (LCSW)
Entity type:Individual
Prefix:MR
First Name:KENDALL
Middle Name:
Last Name:WOLFE
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 1:5520 W WINDSOR AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3509
Mailing Address - Country:US
Mailing Address - Phone:317-362-4847
Mailing Address - Fax:
Practice Address - Street 1:5520 W WINDSOR AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3509
Practice Address - Country:US
Practice Address - Phone:317-362-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490264791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical