Provider Demographics
NPI:1306211594
Name:WOZNICKI, LAWRENCE (MS,CADC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:WOZNICKI
Suffix:
Gender:M
Credentials:MS,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 SAINT CHARLES RD
Mailing Address - Street 2:APT 107
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1146
Mailing Address - Country:US
Mailing Address - Phone:773-777-7112
Mailing Address - Fax:630-559-8467
Practice Address - Street 1:4419 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1021
Practice Address - Country:US
Practice Address - Phone:773-777-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18663101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)