Provider Demographics
NPI:1740669902
Name:WOLF, DAYNA (SAC)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MANOR PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2693
Mailing Address - Country:US
Mailing Address - Phone:920-733-4443
Mailing Address - Fax:920-733-4796
Practice Address - Street 1:930 MANOR PL
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-2693
Practice Address - Country:US
Practice Address - Phone:920-733-4443
Practice Address - Fax:920-733-4796
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15959101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)