1093810400 NPI number — MS. JANET LYNN WOODCOCK MSW LMSW ACSW

Table of content: (NPI 1902131022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093810400 NPI number — MS. JANET LYNN WOODCOCK MSW LMSW ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODCOCK
Provider First Name:
JANET
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LMSW ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093810400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 E WALKER STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ST JOHNS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-227-9000
Provider Business Mailing Address Fax Number:
989-224-0058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E WALKER STREET
Provider Second Line Business Practice Location Address:
ST JOHNS COUNSELING & THERAPY SERVICES PC SUITE B
Provider Business Practice Location Address City Name:
ST JOHNS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-227-9000
Provider Business Practice Location Address Fax Number:
989-224-0058
Provider Enumeration Date:
09/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801034177 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7014234 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1002205 . This is a "MCLAREN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 108548 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8008971270 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".