Provider Demographics
NPI:1518721349
Name:WOODWORTH, VICTORIA LOUISE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LOUISE
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11106 FOUNTAIN GRASS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4149
Mailing Address - Country:US
Mailing Address - Phone:636-445-1270
Mailing Address - Fax:
Practice Address - Street 1:3420 HARRY S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4046
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician