Provider Demographics
NPI:1063070563
Name:WOZNIAK, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 HARRELL AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-2320
Mailing Address - Country:US
Mailing Address - Phone:757-275-4980
Mailing Address - Fax:
Practice Address - Street 1:1456 KEMP BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5057
Practice Address - Country:US
Practice Address - Phone:757-288-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician