Provider Demographics
NPI:1265667299
Name:WOODARD, AUDREY D (MSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:D
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 NE 10TH ST
Mailing Address - Street 2:SUITE C110
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3600
Mailing Address - Country:US
Mailing Address - Phone:405-736-6454
Mailing Address - Fax:405-736-1507
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:SUITE C110
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-736-6454
Practice Address - Fax:405-736-1507
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst