Provider Demographics
NPI:1922103712
Name:WOTRUBA, JOSEPH WILLIAM (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:WOTRUBA
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4906
Mailing Address - Country:US
Mailing Address - Phone:218-728-7173
Mailing Address - Fax:
Practice Address - Street 1:714 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4906
Practice Address - Country:US
Practice Address - Phone:218-728-7173
Practice Address - Fax:651-323-2184
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0693103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling