Provider Demographics
NPI:1154541464
Name:WOLLWAGE, SETH DRUMMOND (LCSW)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:DRUMMOND
Last Name:WOLLWAGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 LYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2226
Mailing Address - Country:US
Mailing Address - Phone:708-445-1160
Mailing Address - Fax:
Practice Address - Street 1:109 W. HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2226
Practice Address - Country:US
Practice Address - Phone:773-677-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical