Provider Demographics
NPI:1992328272
Name:WOLFE, LEAH (MS RDN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S2829 WAUMANDEE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54629-7901
Mailing Address - Country:US
Mailing Address - Phone:608-687-8602
Mailing Address - Fax:
Practice Address - Street 1:S2829 WAUMANDEE CREEK RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN CITY
Practice Address - State:WI
Practice Address - Zip Code:54629-7901
Practice Address - Country:US
Practice Address - Phone:507-858-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86116226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered