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General NPI Number Information
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NPI Number | 1316142540
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Entity Type | Individual
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Provider Name | JILL LAURIE WOODARD ST
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 126 MILLPORT CIR SUITE 201
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City | GREENVILLE
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State | SC
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Zip | 29607-5562
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Country | US
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Telephone | 864-329-1480
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Fax | 864-329-8427
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Provider Business Mailing Address
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Address Line | 2725 WATER RIDGE PKWY SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28217-4580
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Country | US
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Telephone | 704-831-5065
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Fax | 705-831-5066
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 3967
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License Number State | SC
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