Individual provider Active NPI

John A Wolfe, PH.D.

  • Clinical Neuropsychologist
  • Coeur d'Alene, ID
National Provider Identifier
1801870050
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PY00001237 Issued in WA
Practice address
296 W. Sunset Ave
Ste 15
Coeur D'Alene, ID 83815-8366
Phone
(208) 666-0357
Fax
(208) 666-0468
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PY00001237 WA Primary

Addresses

Primary practice location

296 W. Sunset Ave
Ste 15
Coeur D'Alene, ID 83815-8366

Mailing address

296 W. Sunset Ave
Ste 15
Coeur D'Alene, ID 83815-8366
Phone (208) 666-0357

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY00001237WAMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Daniel S Hayes 401K Clinical Neuropsychologist Past Accepting new patients
Paul J Domitor and Associates Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1801870050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 W. SUNSET AVE",
            "address_2": "STE 15",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "838158366",
            "telephone_number": "208-666-0357",
            "fax_number": "208-666-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 W. SUNSET AVE",
            "address_2": "STE 15",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "838158366",
            "telephone_number": "208-666-0357",
            "fax_number": "208-666-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFE",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WA",
            "license": "PY00001237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.