Provider Demographics
NPI:1225099872
Name:WODKA, STEVEN LOUIS (PSY D)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LOUIS
Last Name:WODKA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N PLUM GROVE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5144
Mailing Address - Country:US
Mailing Address - Phone:847-413-9700
Mailing Address - Fax:847-413-1701
Practice Address - Street 1:919 N PLUM GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5144
Practice Address - Country:US
Practice Address - Phone:847-413-9700
Practice Address - Fax:847-413-1701
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical