Provider Demographics
NPI:1588835706
Name:WOODBERRY, FARRAH D
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:D
Last Name:WOODBERRY
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 1:7245 HIGHWAY 908
Mailing Address - Street 2:
Mailing Address - City:BRITTONS NECK
Mailing Address - State:SC
Mailing Address - Zip Code:29546-5085
Mailing Address - Country:US
Mailing Address - Phone:843-362-9911
Mailing Address - Fax:
Practice Address - Street 1:719 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571
Practice Address - Country:US
Practice Address - Phone:843-423-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist