Provider Demographics
NPI:1598483711
Name:WOJTANOWSKI, NICHOLE JESSICA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:JESSICA
Last Name:WOJTANOWSKI
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 1:2345 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7672
Mailing Address - Country:US
Mailing Address - Phone:602-584-2909
Mailing Address - Fax:602-254-3831
Practice Address - Street 1:2345 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7672
Practice Address - Country:US
Practice Address - Phone:602-584-2909
Practice Address - Fax:602-254-3831
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC16653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC16653OtherBOARD