Healthcare Provider Details

I. General information

NPI: 1952492597
Provider Name (Legal Business Name): THERESA H WOJAK M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CEDAR PLAZA PKWY SUITE 350
SAINT LOUIS MO
63128-3854
US

IV. Provider business mailing address

5000 CEDAR PLAZA PKWY SUITE 350
SAINT LOUIS MO
63128-3854
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-4333
  • Fax: 314-843-4856
Mailing address:
  • Phone: 314-843-4333
  • Fax: 314-843-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004674
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: