Healthcare Provider Details

I. General information

NPI: 1629240783
Provider Name (Legal Business Name): JOANNA C WOODS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE SUITE C-202
PHOENIX AZ
85051-9582
US

IV. Provider business mailing address

10000 N 31ST AVE SUITE C-202
PHOENIX AZ
85051-9582
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-6635
  • Fax: 602-997-6642
Mailing address:
  • Phone: 602-997-6635
  • Fax: 602-997-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3833
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: