Provider Demographics
NPI:1144839754
Name:WOLFE, KELLY LAUREN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LAUREN
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LAUREN
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13926 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8617
Mailing Address - Country:US
Mailing Address - Phone:708-289-4990
Mailing Address - Fax:
Practice Address - Street 1:13926 AMELIA DR
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8617
Practice Address - Country:US
Practice Address - Phone:708-289-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional