Provider Demographics
NPI:1275821522
Name:WOODARD, MARIE EDITH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:EDITH
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2451
Mailing Address - Country:US
Mailing Address - Phone:978-630-1146
Mailing Address - Fax:
Practice Address - Street 1:31 LAKE ST. SUITE 180
Practice Address - Street 2:WACHUSETT CRITERION EARLY INTERVENTION
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-632-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA01113922OtherASHA