Provider Demographics
NPI:1952492597
Name:WOJAK, THERESA H (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:H
Last Name:WOJAK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3854
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:314-843-4856
Practice Address - Street 1:5000 CEDAR PLAZA PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3854
Practice Address - Country:US
Practice Address - Phone:314-843-4333
Practice Address - Fax:314-843-4856
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0046741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6298436OtherUBH
MO430985159WOJOtherMERCY HEALTH PLANS
MOO62212OtherEXCLUSIVE CHOICE
MO154436OtherBLUE CROSS BLUE SHIELD
MO124638OtherVALUE OPTIONS
MO287544OtherHEALTHLINK
MO091244000OtherAETNA GROUP ID
MO000078362Medicare ID - Type Unspecified