MEDICARE: HEIDI KIM WODRICH LPC, NCC

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	101YP2500X	Professional Counselor	178006378	IL

General Provider Information

NPI Number	:	1982029997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI KIM WODRICH LPC, NCC

Provider Business Mailing Address
First Line	:	314 GREENVIEW LN
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-6461
Country	:	US
Telephone Number	:	847-354-0354
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 GREENVIEW LN
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-6461
Country	:	US
Telephone Number	:	847-354-0354
Fax Number	:	847-265-9331

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

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	03/11/2026

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