Provider Demographics
NPI:1013562412
Name:WOODS, MANDI ELIZABETH (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:ELIZABETH
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 3RD AVE APT F203
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6000
Mailing Address - Country:US
Mailing Address - Phone:269-267-1857
Mailing Address - Fax:
Practice Address - Street 1:929 3RD AVE APT F203
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6000
Practice Address - Country:US
Practice Address - Phone:269-267-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60916205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist