Healthcare Provider Details

I. General information

NPI: 1003431180
Provider Name (Legal Business Name): LAURA K WOITAS MA, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 SKOKIE BLVD STE 207
SKOKIE IL
60077-2272
US

IV. Provider business mailing address

6565 N HARLEM AVE APT 3N
CHICAGO IL
60631-3925
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-8577
  • Fax:
Mailing address:
  • Phone: 630-209-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: