MEDICARE: KIMBERLY ZOE WOODRICH BS

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	101YM0800X	Mental Health Counselor

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

General Provider Information

NPI Number	:	1578175451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ZOE WOODRICH BS

Provider Business Mailing Address
First Line	:	PO BOX 1288
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0368
Country	:	US
Telephone Number	:	541-464-6664
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 SE JACKSON ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3341
Country	:	US
Telephone Number	:	541-464-6664
Fax Number	:

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

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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