Healthcare Provider Details

I. General information

NPI: 1144729112
Provider Name (Legal Business Name): VASHANDRA WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ST. TAMMANY ST
BATON ROUGE LA
70806
US

IV. Provider business mailing address

1301 YOUREE DR.
SHREVEPORT LA
71101
US

V. Phone/Fax

Practice location:
  • Phone: 225-929-9738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: