Provider Demographics
NPI:1538336748
Name:JOHN A WOLFE, PH.D., LLC AND ASSOCIATES
Entity type:Organization
Organization Name:JOHN A WOLFE, PH.D., LLC AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-666-0357
Mailing Address - Street 1:296 W. SUNSET AVE
Mailing Address - Street 2:STE 15
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8366
Mailing Address - Country:US
Mailing Address - Phone:208-666-0357
Mailing Address - Fax:208-666-0468
Practice Address - Street 1:296 W. SUNSET AVE
Practice Address - Street 2:STE 15
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8366
Practice Address - Country:US
Practice Address - Phone:208-666-0357
Practice Address - Fax:208-666-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202250103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty