Provider Demographics
NPI:1447764675
Name:WOODRUM, JESSICA RENEE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RENEE
Last Name:WOODRUM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5201 IRWIN RD APT 9
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3264
Mailing Address - Country:US
Mailing Address - Phone:304-544-6758
Mailing Address - Fax:304-736-4835
Practice Address - Street 1:1000 5TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2238
Practice Address - Country:US
Practice Address - Phone:304-733-0036
Practice Address - Fax:304-736-4835
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker