MEDICARE: LISA WOODGATE

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	235Z00000X	Speech-Language Pathologist	SLP2110	AZ
2	235Z00000X	Speech-Language Pathologist	SA 633	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194876250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WOODGATE

Provider Business Mailing Address
First Line	:	22850 W SIERRA RIDGE WAY
Second Line	:
City	:	WITTMANN
State	:	AZ
Zip	:	85361-8785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21419 W DOVE VALLEY RD
Second Line	:
City	:	WITTMANN
State	:	AZ
Zip	:	85361
Country	:	US
Telephone Number	:	623-388-2321
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/09/2007

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Directions to “ LISA WOODGATE ” Practice Location

Language	Start Address	Practice Location

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