Healthcare Provider Details

I. General information

NPI: 1710734546
Provider Name (Legal Business Name): MADISON ANNE WOZNIAK LCSW, SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 MCCLINTOCK DR STE 100
BURR RIDGE IL
60527-0863
US

IV. Provider business mailing address

1120 S WILLIAMS ST APT B5
WESTMONT IL
60559-2947
US

V. Phone/Fax

Practice location:
  • Phone: 630-491-6846
  • Fax:
Mailing address:
  • Phone: 616-916-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22801
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: