Individual
ALEXANDRA ELIZABETH WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
515 S 700 E STE 2A, SALT LAKE CITY, UT 84102-2855
(801) 935-4171
Mailing address
1511 25TH ST, OGDEN, UT 84401-2923
(717) 462-8582
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
106S00000X
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PZO130804572001
INDEPENDENCE BLUE CROSS
PA
Enumeration date
12/23/2020
Last updated
12/23/2020
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