Provider Demographics
NPI:1063705861
Name:DR. JO WOLTHUSEN
Entity type:Organization
Organization Name:DR. JO WOLTHUSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSY.D.
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTHUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-826-5881
Mailing Address - Street 1:3413 N KENNICOTT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7815
Mailing Address - Country:US
Mailing Address - Phone:847-826-5881
Mailing Address - Fax:
Practice Address - Street 1:3413 N KENNICOTT AVE STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7815
Practice Address - Country:US
Practice Address - Phone:847-826-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty