Provider Demographics
NPI:1821800095
Name:WOLF, JURNEY ESTELLE
Entity type:Individual
Prefix:
First Name:JURNEY
Middle Name:ESTELLE
Last Name:WOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CHARLESTON LN
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-8027
Mailing Address - Country:US
Mailing Address - Phone:954-798-5597
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE RD STE 209
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1727
Practice Address - Country:US
Practice Address - Phone:847-458-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-23-306684106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician