MEDICARE: JEREMY MICHAEL WOOLDRIDGE LCSW

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	1041C0700X	Clinical Social Worker	6273-C	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5DD43	OTHER	AR	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922275213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MICHAEL WOOLDRIDGE LCSW

Provider Business Mailing Address
First Line	:	6009 CW POST RD
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401
Country	:	US
Telephone Number	:	870-932-0228
Fax Number	:	870-910-5689

Provider Business Practice Location Address
First Line	:	6009 CW POST RD
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401
Country	:	US
Telephone Number	:	870-932-0228
Fax Number	:	870-910-5689

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	01/19/2022

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