Healthcare Provider Details

I. General information

NPI: 1700795911
Provider Name (Legal Business Name): JALYNN SIMONE WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SLATER RD
DURHAM NC
27703-8468
US

IV. Provider business mailing address

938 SLATEWORTH DR
DURHAM NC
27703-6178
US

V. Phone/Fax

Practice location:
  • Phone: 419-239-7501
  • Fax:
Mailing address:
  • Phone: 419-239-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-489431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: