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General NPI Number Information
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NPI Number | 1841705472
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Entity Type | Organization
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Legal Business Name | JENNIFER WOODARD LCSW LLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 302 S COLLEGE AVE APT 210
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City | FORT COLLINS
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State | CO
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Zip | 80524-3480
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Country | US
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Telephone | 970-443-5016
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Fax | 970-443-5016
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Provider Business Mailing Address
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Address Line | 1530 FREEDOM LN
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City | FORT COLLINS
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State | CO
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Zip | 80526-1707
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Country | US
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Telephone | 970-443-5016
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | JENNIFER WOODARD
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Credential | LCSW
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Telephone | 970-443-5016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1574
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License Number State | CO
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