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NPI Code Detail

MEDICARE: PAIGE DYER WOODARD M.A

MEDICARE: PAIGE DYER WOODARD M.A
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) Counselor
2103TR0400XRehabilitation Psychologist
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1437678224
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAIGE DYER WOODARD M.A
Provider Business Mailing Address
First Line : 1809 E ANITA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4232
Country : US
Telephone Number : 209-639-5009
Fax Number :
Provider Business Practice Location Address
First Line : 10400 FRICOT CITY RD
Second Line :
City : SAN ANDREAS
State : CA
Zip : 95249-9642
Country : US
Telephone Number : 209-736-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 09/13/2017

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