Provider Demographics
NPI:1710734546
Name:WOZNIAK, MADISON ANNE (LCSW, SW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANNE
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:LCSW, SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S WILLIAMS ST APT B5
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2947
Mailing Address - Country:US
Mailing Address - Phone:616-916-7974
Mailing Address - Fax:
Practice Address - Street 1:745 MCCLINTOCK DR STE 100
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0863
Practice Address - Country:US
Practice Address - Phone:630-491-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW228011041C0700X
IL149.0275751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical