Provider Demographics
NPI:1669604948
Name:WODLINGER, PATRICIA W (LPC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:W
Last Name:WODLINGER
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 1:805 HAMPTON PLACE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708
Mailing Address - Country:US
Mailing Address - Phone:417-235-6530
Mailing Address - Fax:417-476-1081
Practice Address - Street 1:104 W MAIN
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723-2100
Practice Address - Country:US
Practice Address - Phone:417-476-1000
Practice Address - Fax:417-476-1081
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO120411193148705Medicaid