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General NPI Number Information
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NPI Number | 1316486764
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Entity Type | Individual
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Provider Name | MIKALYN RAYANN WOODRUFF
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Gender | Female
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 3801 KERN WAY
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City | YAKIMA
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State | WA
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Zip | 98902-6340
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Country | US
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Telephone | 509-574-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 918 EAST MEAD AVENUE
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City | YAKIMA
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State | WA
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Zip | 98903-3720
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Country | US
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Telephone | 509-453-1344
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Fax | 509-453-2209
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CG60733093
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | CG 60733093
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License Number State | WA
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