Provider Demographics
NPI:1235641754
Name:WOJTAS, VICKY MARLENE (CADC 23313)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:MARLENE
Last Name:WOJTAS
Suffix:
Gender:F
Credentials:CADC 23313
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 TOLLGATE RD STE E
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9323
Mailing Address - Country:US
Mailing Address - Phone:847-462-6099
Mailing Address - Fax:847-628-6064
Practice Address - Street 1:585 TOLLGATE RD STE E
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9323
Practice Address - Country:US
Practice Address - Phone:847-462-6099
Practice Address - Fax:847-628-6064
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23313101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)