Healthcare Provider Details

I. General information

NPI: 1326705856
Provider Name (Legal Business Name): DAMIANA DARCILLE WOODYARD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 OLD JACKSBORO HWY, ST 101
WICHITA FALLS TX
76302
US

IV. Provider business mailing address

4309 OLD JACKSBORO HWY, ST 101
WICHITA FALLS TX
76302
US

V. Phone/Fax

Practice location:
  • Phone: 940-386-1004
  • Fax: 940-386-9944
Mailing address:
  • Phone: 940-386-1004
  • Fax: 940-386-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: