Provider Demographics
NPI:1679189807
Name:WOLFE, MITCHELL DUNCAN
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DUNCAN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 18TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3409
Mailing Address - Country:US
Mailing Address - Phone:360-525-4190
Mailing Address - Fax:
Practice Address - Street 1:5261 18TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3409
Practice Address - Country:US
Practice Address - Phone:360-525-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician