Provider Demographics
NPI:1346655776
Name:WOODWARD, MELISSA (MS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1010
Mailing Address - Country:US
Mailing Address - Phone:224-678-2013
Mailing Address - Fax:
Practice Address - Street 1:1100 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1010
Practice Address - Country:US
Practice Address - Phone:224-678-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator