Healthcare Provider Details

I. General information

NPI: 1780899609
Provider Name (Legal Business Name): RENEE ANDRADE WOODALL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 REDWING RD STE 316
FORT COLLINS CO
80526-2879
US

IV. Provider business mailing address

2629 REDWING RD STE 316
FORT COLLINS CO
80526-2879
US

V. Phone/Fax

Practice location:
  • Phone: 970-556-5836
  • Fax: 970-837-3352
Mailing address:
  • Phone: 970-556-5836
  • Fax: 970-837-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3173
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: