Provider Demographics
NPI:1427712314
Name:WOLFE, JILIAN (CADC R)
Entity type:Individual
Prefix:
First Name:JILIAN
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CADC R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 NE HOLLIDAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6033
Mailing Address - Country:US
Mailing Address - Phone:541-630-6961
Mailing Address - Fax:
Practice Address - Street 1:23 NW GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2078
Practice Address - Country:US
Practice Address - Phone:541-383-4293
Practice Address - Fax:541-383-4935
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-21-1050101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)