MEDICARE: LISA WOODCOX

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1609265305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WOODCOX

Provider Business Mailing Address
First Line	:	9324 E COUNTY LINE RD
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-9617
Country	:	US
Telephone Number	:	231-920-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	9324 E COUNTY LINE RD
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-9617
Country	:	US
Telephone Number	:	231-920-0190
Fax Number	:

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

Provider Enumeration Date	:	01/19/2015
Last Update Date	:	01/19/2015

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Directions to “ LISA WOODCOX ” Practice Location

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