Provider Demographics
NPI:1982029997
Name:WODRICH, HEIDI KIM (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KIM
Last Name:WODRICH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6461
Mailing Address - Country:US
Mailing Address - Phone:847-354-0354
Mailing Address - Fax:
Practice Address - Street 1:314 GREENVIEW LN
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6461
Practice Address - Country:US
Practice Address - Phone:847-354-0354
Practice Address - Fax:847-265-9331
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional