Healthcare Provider Details

I. General information

NPI: 1093510273
Provider Name (Legal Business Name): JENNIFER WOODARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13211 CHAPELSIDE AVE
CLEVELAND OH
44120-4605
US

IV. Provider business mailing address

1653 E 75TH ST
CLEVELAND OH
44103-4111
US

V. Phone/Fax

Practice location:
  • Phone: 216-820-5183
  • Fax:
Mailing address:
  • Phone: 216-820-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number396670
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number396670
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number396670
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number396670
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number396670
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number396670
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number396670
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number396670
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number396670
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number396670
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number396670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: