Provider Demographics
NPI:1558714543
Name:ATWOOD, JAMIE (MA)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:WOOLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 RIPLEY T-3
Mailing Address - Street 2:
Mailing Address - City:OXLY
Mailing Address - State:MO
Mailing Address - Zip Code:63955-5935
Mailing Address - Country:US
Mailing Address - Phone:573-680-4287
Mailing Address - Fax:
Practice Address - Street 1:509 RIPLEY T-3
Practice Address - Street 2:
Practice Address - City:OXLY
Practice Address - State:MO
Practice Address - Zip Code:63955-5935
Practice Address - Country:US
Practice Address - Phone:573-680-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016018373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional