Provider Demographics
NPI:1801017538
Name:WOLFF, MICHELLE L (PPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WOLFF
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E STUART ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1550
Mailing Address - Country:US
Mailing Address - Phone:307-421-2720
Mailing Address - Fax:307-433-8785
Practice Address - Street 1:1901 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3759
Practice Address - Country:US
Practice Address - Phone:307-638-4092
Practice Address - Fax:307-433-8785
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCC-311101YA0400X
WYPPC-311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health