MEDICARE: BRANDON K WOODERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1073059879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON K WOODERS

Provider Business Mailing Address
First Line	:	3484 CEDARCREST AVE APT 405
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2003
Country	:	US
Telephone Number	:	225-478-9533
Fax Number	:	225-478-9534

Provider Business Practice Location Address
First Line	:	3484 CEDARCREST AVE APT 405
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2003
Country	:	US
Telephone Number	:	225-478-9533
Fax Number	:	225-478-9534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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