Healthcare Provider Details

I. General information

NPI: 1457515231
Provider Name (Legal Business Name): ELIZABETH ANN WOODEN M.A.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 KERRY ANN WAY
JEFFERSONVILLE IN
47130-8669
US

IV. Provider business mailing address

3642 KERRY ANN WAY
JEFFERSONVILLE IN
47130-8669
US

V. Phone/Fax

Practice location:
  • Phone: 812-989-7680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004277A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: