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NPI Code Detail

MEDICARE: ERIC WOODARD LAC

MEDICARE: ERIC WOODARD LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1374ND
2104100000XSocial Worker1518ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2012458OTHERNDBCBS PIN

General Provider Information

NPI Number : 1144264391
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC WOODARD LAC
Provider Business Mailing Address
First Line : PO BOX 650
Second Line :
City : DEVILS LAKE
State : ND
Zip : 58301-0650
Country : US
Telephone Number : 701-665-2200
Fax Number : 701-665-2300
Provider Business Practice Location Address
First Line : 200 HIGHWAY 2 W
Second Line :
City : DEVILS LAKE
State : ND
Zip : 58301-3532
Country : US
Telephone Number : 701-665-2200
Fax Number : 701-665-2300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 07/19/2007

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Directions to “ ERIC WOODARD LAC” Practice Location

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