Provider Demographics
NPI:1497861421
Name:WOODARD, ABBIE VICTORIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ABBIE
Middle Name:VICTORIA
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 1:3304 NORTHSHORE CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1304
Mailing Address - Country:US
Mailing Address - Phone:850-228-6027
Mailing Address - Fax:850-807-2970
Practice Address - Street 1:15 N STEWART ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-875-2180
Practice Address - Fax:850-807-2970
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891620900Medicaid