Healthcare Provider Details

I. General information

NPI: 1659225712
Provider Name (Legal Business Name): WOODFERN PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W PRATT BLVD APT 2N
CHICAGO IL
60626-4418
US

IV. Provider business mailing address

1126 W PRATT BLVD APT 2N
CHICAGO IL
60626-4418
US

V. Phone/Fax

Practice location:
  • Phone: 847-780-7044
  • Fax:
Mailing address:
  • Phone: 847-780-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DENTON WOODFERN
Title or Position: LCSW
Credential:
Phone: 847-780-7044