Provider Demographics
NPI:1194848069
Name:WOZNICKI, SANDRA E (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:E
Last Name:WOZNICKI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4037
Mailing Address - Country:US
Mailing Address - Phone:815-338-8506
Mailing Address - Fax:
Practice Address - Street 1:227 N THROOP ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3224
Practice Address - Country:US
Practice Address - Phone:815-206-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005632186OtherBLUECROSSBLUESHIELD OF IL