Provider Demographics
NPI:1902479876
Name:AVI VODNOY WOLF, LLC
Entity Type:Organization
Organization Name:AVI VODNOY WOLF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVI
Authorized Official - Middle Name:VODNOY
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:219-928-8685
Mailing Address - Street 1:1301 W MORSE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-7306
Mailing Address - Country:US
Mailing Address - Phone:219-928-8685
Mailing Address - Fax:
Practice Address - Street 1:1301 W MORSE AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-7306
Practice Address - Country:US
Practice Address - Phone:219-928-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center