Provider Demographics
NPI:1346792322
Name:WOJTKOWIAK, KRYSTAL (LPC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:WOJTKOWIAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8970
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0970
Mailing Address - Country:US
Mailing Address - Phone:419-475-4449
Mailing Address - Fax:
Practice Address - Street 1:123 22ND ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2706
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1600315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health