Healthcare Provider Details

I. General information

NPI: 1093810400
Provider Name (Legal Business Name): JANET LYNN WOODCOCK MSW LMSW ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E WALKER STREET ST JOHNS COUNSELING & THERAPY SERVICES PC SUITE B
ST JOHNS MI
48879
US

IV. Provider business mailing address

120 E WALKER STREET SUITE B
ST JOHNS MI
48879
US

V. Phone/Fax

Practice location:
  • Phone: 989-227-9000
  • Fax: 989-224-0058
Mailing address:
  • Phone: 989-227-9000
  • Fax: 989-224-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801034177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: