Provider Demographics
NPI:1740958297
Name:HELEN WOODRUM LCSW PLLC
Entity type:Organization
Organization Name:HELEN WOODRUM LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-277-1049
Mailing Address - Street 1:114 E EVERETT ST STE 208
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2140
Mailing Address - Country:US
Mailing Address - Phone:815-994-6400
Mailing Address - Fax:
Practice Address - Street 1:114 E EVERETT ST STE 208
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-2140
Practice Address - Country:US
Practice Address - Phone:815-994-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149015750OtherIL DEPT. FINANCIAL AND PROF. REGULATION
IL149015750OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION- LCSW
IL12588016OtherCAQH