Provider Demographics
NPI:1528147360
Name:WOLFF, MICHAEL PAUL (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:WOLFF
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Gender:M
Credentials:PSYD
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Mailing Address - Street 1:7138 LAKE VISTA DR SW
Mailing Address - Street 2:APARTMENT #2B
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8547
Mailing Address - Country:US
Mailing Address - Phone:616-583-0803
Mailing Address - Fax:616-365-8971
Practice Address - Street 1:3351 EAGLE RUN DR NE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7053
Practice Address - Country:US
Practice Address - Phone:616-365-8920
Practice Address - Fax:616-365-8971
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI6301012443103G00000X, 103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1528147360OtherCLINICAL NEUROPSYCHOLOGIS