Provider Demographics
NPI:1609528850
Name:WOODARD, ERICKA
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:WOODARD
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 1:5826 SW 26TH TER
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4116
Mailing Address - Country:US
Mailing Address - Phone:954-665-9178
Mailing Address - Fax:
Practice Address - Street 1:7451 WILES RD STE 107
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2040
Practice Address - Country:US
Practice Address - Phone:954-893-2442
Practice Address - Fax:954-516-7631
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113131700Medicaid