Provider Demographics
NPI:1003431180
Name:WOITAS, LAURA K (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:WOITAS
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 N HARLEM AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3925
Mailing Address - Country:US
Mailing Address - Phone:630-209-6782
Mailing Address - Fax:
Practice Address - Street 1:8707 SKOKIE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2272
Practice Address - Country:US
Practice Address - Phone:847-673-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program