MEDICARE: SEAN WOODFORD PSYD, CADC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1548127194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN WOODFORD PSYD, CADC

Provider Business Mailing Address
First Line	:	405 WASHINGTON BLVD STE 201
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-3104
Country	:	US
Telephone Number	:	847-566-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 WASHINGTON BLVD STE 201
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-3104
Country	:	US
Telephone Number	:	847-566-0164
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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