Healthcare Provider Details

I. General information

NPI: 1033633367
Provider Name (Legal Business Name): CHLOE 1 WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 S LAFOUNTAIN ST STE C
KOKOMO IN
46902
US

IV. Provider business mailing address

3423 S LAFOUNTAIN ST STE C
KOKOMO IN
46902-3857
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-5773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010785A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33010075A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: