Healthcare Provider Details

I. General information

NPI: 1831512151
Provider Name (Legal Business Name): CHRIS WOODWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 LINCOLNSHIRE DR
CHAMPAIGN IL
61821-5606
US

IV. Provider business mailing address

808 W NEVADA ST
URBANA IL
61801-3801
US

V. Phone/Fax

Practice location:
  • Phone: 217-355-1697
  • Fax:
Mailing address:
  • Phone: 217-414-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: