Provider Demographics
NPI:1598483711
Name:WOJTANOWSKI, NICHOLE JESSICA (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:JESSICA
Last Name:WOJTANOWSKI
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 1:1163 E WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4260
Mailing Address - Country:US
Mailing Address - Phone:602-791-5053
Mailing Address - Fax:
Practice Address - Street 1:1163 E WINDSOR DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4260
Practice Address - Country:US
Practice Address - Phone:602-791-5053
Practice Address - Fax:602-254-3831
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC16653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC16653OtherBOARD