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General NPI Number Information
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NPI Number | 1205982279
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Entity Type | Individual
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Provider Name | MARY WOODWARD MA, LP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 13800 NICOLLET BLVD UNIT 1612
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City | BURNSVILLE
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State | MN
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Zip | 55337-6134
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Country | US
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Telephone | 612-803-1953
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Fax | 651-454-9494
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Provider Business Mailing Address
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Address Line | 13800 NICOLLET BLVD UNIT 1612
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City | BURNSVILLE
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State | MN
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Zip | 55337-6134
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Country | US
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Telephone | 612-803-1953
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Fax | 651-454-9494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | LP 3003
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License Number State | MN
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