Healthcare Provider Details

I. General information

NPI: 1013090984
Provider Name (Legal Business Name): REBECCA WOODROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LYDA AVE
BOWLING GREEN KY
42104-3326
US

IV. Provider business mailing address

104 REYNOLDS RD
GLASGOW KY
42141-1177
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-6567
  • Fax: 270-904-6570
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY-1188
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: