MEDICARE: THEODORE ROY WOODRUFF CRM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	T-20-391	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14-CRM-024	OTHER	OR	MHACBO CRM

General Provider Information

NPI Number	:	1003325200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE ROY WOODRUFF CRM

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VIRGINIA AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-3477
Country	:	US
Telephone Number	:	541-751-0357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	03/04/2026

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Directions to “ THEODORE ROY WOODRUFF CRM” Practice Location

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