Healthcare Provider Details

I. General information

NPI: 1700583457
Provider Name (Legal Business Name): HEATHER WOODARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GRANDE BLVD SE STE B
RIO RANCHO NM
87124-1695
US

IV. Provider business mailing address

2200 GRANDE BLVD SE STE B
RIO RANCHO NM
87124-1695
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6383
  • Fax: 505-636-6338
Mailing address:
  • Phone: 505-218-6383
  • Fax: 505-636-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM11627
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: