Provider Demographics
NPI:1639713241
Name:WOODS, MIRJUM KAREENE
Entity Type:Individual
Prefix:
First Name:MIRJUM
Middle Name:KAREENE
Last Name:WOODS
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 1:38730 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:OR
Mailing Address - Zip Code:97431-9797
Mailing Address - Country:US
Mailing Address - Phone:541-653-5262
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3871
Practice Address - Country:US
Practice Address - Phone:541-790-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker