Provider Demographics
NPI:1659490431
Name:WOODFILL, JOHN WARREN (MA MED)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WARREN
Last Name:WOODFILL
Suffix:
Gender:M
Credentials:MA MED
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19 WOODFILL ROAD
Mailing Address - Street 2:
Mailing Address - City:LINDRITH
Mailing Address - State:NM
Mailing Address - Zip Code:87029-0113
Mailing Address - Country:US
Mailing Address - Phone:505-774-6672
Mailing Address - Fax:505-774-6664
Practice Address - Street 1:19 WOODFILL ROAD
Practice Address - Street 2:
Practice Address - City:LINDRITH
Practice Address - State:NM
Practice Address - Zip Code:87029-0113
Practice Address - Country:US
Practice Address - Phone:505-774-6672
Practice Address - Fax:505-774-6664
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant