Provider Demographics
NPI:1114178803
Name:WOODBURY, JENNIFER DIANA MARIE (MDE)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:DIANA MARIE
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:MDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BARNARD RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4407
Mailing Address - Country:US
Mailing Address - Phone:781-821-3499
Mailing Address - Fax:781-821-3905
Practice Address - Street 1:1 WHITMAN ROAD
Practice Address - Street 2:CLARKE SCHOOL EAST
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-821-3499
Practice Address - Fax:781-821-3905
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA400255235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist