MEDICARE: RENEE A WOODALL PHD PROFESSIONAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	103TA0700X	Adult Development & Aging Psychologist
3	103TB0200X	Cognitive & Behavioral Psychologist
4	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1407094469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEE A WOODALL PHD PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	2629 REDWING RD STE 316
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2879
Country	:	US
Telephone Number	:	970-556-5836
Fax Number	:	970-837-3352

Provider Business Practice Location Address
First Line	:	2629 REDWING RD STE 316
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2879
Country	:	US
Telephone Number	:	970-556-5836
Fax Number	:	970-837-3352

Authorized Official
Title or Position	:	OWNER AND LICENSED PSYCHOLOGIST
Name	:	DR. RENEE ANDRADE WOODALL
Credential	:	PH.D.
Telephone Number	:	970-556-5836

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	03/13/2023

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