Healthcare Provider Details

I. General information

NPI: 1952987950
Provider Name (Legal Business Name): CHANTAL WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

6648 HAMILTON RD
LIBERTY TOWNSHIP OH
45044-9310
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-3562
  • Fax:
Mailing address:
  • Phone: 513-432-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: