Active NPI
Keith Wolf
- Clinical Social Worker
- Anitgo, WI
National Provider Identifier
1881781680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 455-123
- Practice address
- 1225 Langlade Road
Anitgo, WI 54409 - Phone
- (715) 623-2394
- Fax
- (715) 627-4194
- NPI assigned
- Oct 5, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 455-123 | WI | Primary |
Addresses
Primary practice location
1225 Langlade Road
Anitgo, WI 54409
Mailing address
1100 Lake View Drive
Wausau, WI 54403
Phone (715) 848-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39629300 | Medicaid | WI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 455-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881781680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 LAKE VIEW DRIVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "54403",
"telephone_number": "715-848-4600",
"fax_number": "715-845-5398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 LANGLADE ROAD",
"city": "ANITGO",
"state": "WI",
"postal_code": "54409",
"telephone_number": "715-623-2394",
"fax_number": "715-627-4194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "KEITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "455-123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39629300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anitgo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.