Provider Demographics
NPI:1174163976
Name:WOJTOWICZ, KRYSTYNA JANINA (MA, LCPC)
Entity type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:JANINA
Last Name:WOJTOWICZ
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:KRYSTYNA
Other - Middle Name:JANINA
Other - Last Name:LISZEWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3220
Mailing Address - Country:US
Mailing Address - Phone:847-802-4058
Mailing Address - Fax:815-344-5072
Practice Address - Street 1:111 DEAN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3220
Practice Address - Country:US
Practice Address - Phone:847-802-4058
Practice Address - Fax:815-344-5072
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional