Organization
LAC COURTE OREILLES GOVERNING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY WOLF (DIRECTOR)
(715) 558-7939
Entity
Organization
Contact information
Practice address
13856 W CORBINE DR, STONE LAKE, WI 54876-4001
(715) 558-7939
Mailing address
13856 W CORBINE DR, STONE LAKE, WI 54876-4001
(715) 558-7939
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
12/10/2025
Last updated
12/10/2025
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