MEDICARE: LAURA L WOZNIAK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ORL2537	OR

General Provider Information

NPI Number	:	1487642047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L WOZNIAK LCSW

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	503-643-7565
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2023
Country	:	US
Telephone Number	:	503-643-7565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/12/2007

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