Provider Demographics
NPI:1235226762
Name:WOODARD, CARDYON ONETA MITCHELL (LICENSED DISPENSER)
Entity Type:Individual
Prefix:MS
First Name:CARDYON
Middle Name:ONETA MITCHELL
Last Name:WOODARD
Suffix:
Gender:F
Credentials:LICENSED DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 50TH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414
Mailing Address - Country:US
Mailing Address - Phone:806-799-8950
Mailing Address - Fax:806-792-9404
Practice Address - Street 1:1600 COULTER
Practice Address - Street 2:BLDG A STE 105
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-352-2321
Practice Address - Fax:806-355-8941
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50197237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist