Provider Demographics
NPI:1124587332
Name:WOODRUFF, LISA DAWN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14613 SALT MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-9547
Mailing Address - Country:US
Mailing Address - Phone:703-628-7491
Mailing Address - Fax:
Practice Address - Street 1:14613 SALT MEADOW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-9547
Practice Address - Country:US
Practice Address - Phone:703-628-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency