Provider Demographics
NPI:1326181686
Name:PLOETZ, JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:
Last Name:PLOETZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 RIDGE AVE
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5918
Mailing Address - Country:US
Mailing Address - Phone:847-866-8591
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE
Practice Address - Street 2:SUITE 101B
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5918
Practice Address - Country:US
Practice Address - Phone:847-866-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490004361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205821Medicare ID - Type Unspecified