Healthcare Provider Details

I. General information

NPI: 1609987593
Provider Name (Legal Business Name): ELLEN T WOODRUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COMMUNITY
CLINTON MO
64735-8804
US

IV. Provider business mailing address

32204 E OAKLAND SCHOOL RD
BUCKNER MO
64016-7106
US

V. Phone/Fax

Practice location:
  • Phone: 816-728-3650
  • Fax:
Mailing address:
  • Phone: 816-517-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number915
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: