Active NPI
Jessica Wolf, LCPC
- Professional Counselor
- Bloomington, IL
National Provider Identifier
1568973279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180011245
- Practice address
- 502 S Morris Ave
Bloomington, IL 61701-4884 - Phone
- (309) 820-7616
- Fax
- (309) 820-7657
- NPI assigned
- Oct 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180011245 | IL | Primary |
Addresses
Primary practice location
502 S Morris Ave
Bloomington, IL 61701-4884
Mailing address
128 N Michigan St Apt C
El Paso, IL 61738-1076
Phone (815) 326-2513
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241011002984 | IL | Practitioner - Mental Health Counselor | 7719419076 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180011245 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508457600000",
"number": "1568973279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 N MICHIGAN ST APT C",
"city": "EL PASO",
"state": "IL",
"postal_code": "617381076",
"telephone_number": "815-326-2513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 S MORRIS AVE",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617014884",
"telephone_number": "309-820-7616",
"fax_number": "309-820-7657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "JESSICA",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-20",
"last_updated": "2017-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180011245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.