Provider Demographics
NPI:1205007242
Name:WOODRUFF, KERI LYNN (BA, SST)
Entity Type:Individual
Prefix:MS
First Name:KERI
Middle Name:LYNN
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:BA, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35555 GARFIELD ROAD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035
Mailing Address - Country:US
Mailing Address - Phone:586-792-1654
Mailing Address - Fax:586-792-1656
Practice Address - Street 1:35555 GARFIELD RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-5517
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:586-792-1656
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085909171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator