Provider Demographics
NPI:1013403708
Name:WOODARD, ANDRA DAWN (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDRA
Middle Name:DAWN
Last Name:WOODARD
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:ANDRA
Other - Middle Name:DAWN
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2076
Mailing Address - Country:US
Mailing Address - Phone:907-224-5850
Mailing Address - Fax:360-868-1461
Practice Address - Street 1:10599 FOX CIR
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664
Practice Address - Country:US
Practice Address - Phone:907-491-1581
Practice Address - Fax:360-868-1461
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK105894104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK105894OtherALASKA STATE LICENSE