Provider Demographics
NPI:1437727773
Name:PATRICIA WITVOET PLLC
Entity Type:Organization
Organization Name:PATRICIA WITVOET PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITVOET
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-793-0840
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-8592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15020 S RAVINIA AVE STE 23
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5352
Practice Address - Country:US
Practice Address - Phone:708-793-0840
Practice Address - Fax:844-798-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty