Provider Demographics
NPI:1740502004
Name:WOLD, MARY KATHERINE (BSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:WOLD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:WOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974-1210
Mailing Address - Country:US
Mailing Address - Phone:150-749-8356
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:1407 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3301
Practice Address - Country:US
Practice Address - Phone:160-878-5626
Practice Address - Fax:160-878-5631
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator