Provider Demographics
NPI:1417131145
Name:WOODWARD, JAMES JEFFREY (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JEFFREY
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-4502
Mailing Address - Country:US
Mailing Address - Phone:304-636-9150
Mailing Address - Fax:
Practice Address - Street 1:40 11TH ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4502
Practice Address - Country:US
Practice Address - Phone:304-636-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11103103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool