Provider Demographics
NPI:1437693736
Name:WOODHAM, LEIDA A (LPC)
Entity type:Individual
Prefix:
First Name:LEIDA
Middle Name:A
Last Name:WOODHAM
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 12
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-0012
Mailing Address - Country:US
Mailing Address - Phone:815-556-2579
Mailing Address - Fax:630-593-7579
Practice Address - Street 1:PO BOX 12
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-0012
Practice Address - Country:US
Practice Address - Phone:815-556-2579
Practice Address - Fax:630-593-7579
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health