Healthcare Provider Details

I. General information

NPI: 1427348267
Provider Name (Legal Business Name): MILO WOODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 AURORA AVE SUITE 9 & 10
BOULDER CO
80303-2250
US

IV. Provider business mailing address

1670 LINDEN AVE
BOULDER CO
80304-1536
US

V. Phone/Fax

Practice location:
  • Phone: 303-245-0916
  • Fax:
Mailing address:
  • Phone: 303-443-9567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: