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NPI Code Detail

MEDICARE: JENNIFER WOODARD LCSW LLC

MEDICARE: JENNIFER WOODARD LCSW LLC
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
11041C0700XClinical Social Worker1574CO

General Provider Information

NPI Number : 1841705472
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENNIFER WOODARD LCSW LLC
Provider Business Mailing Address
First Line : 1530 FREEDOM LN
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1707
Country : US
Telephone Number : 970-443-5016
Fax Number :
Provider Business Practice Location Address
First Line : 302 S COLLEGE AVE APT 210
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-3480
Country : US
Telephone Number : 970-443-5016
Fax Number : 970-443-5016
Authorized Official
Title or Position : LICENSED CLINICAL SOCIAL WORKER
Name : JENNIFER WOODARD
Credential : LCSW
Telephone Number : 970-443-5016
Provider Enumeration Date : 12/05/2017
Last Update Date : 12/05/2017

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