Provider Demographics
NPI:1609166156
Name:WOLFE, JEFFREY C (MT-BC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4566 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5502
Mailing Address - Country:US
Mailing Address - Phone:330-808-0859
Mailing Address - Fax:
Practice Address - Street 1:2008 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1017
Practice Address - Country:US
Practice Address - Phone:847-905-1500
Practice Address - Fax:847-251-5391
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist