Provider Demographics
NPI:1659502797
Name:ABBIE V. WOODARD, MS CCC-SLP, INC.
Entity Type:Organization
Organization Name:ABBIE V. WOODARD, MS CCC-SLP, INC.
Other - Org Name:NORTH FLORIDA THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBIE
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:850-228-6027
Mailing Address - Street 1:3304 NORTHSHORE CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1304
Mailing Address - Country:US
Mailing Address - Phone:850-228-6027
Mailing Address - Fax:850-807-2970
Practice Address - Street 1:15 N STEWART ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-875-2180
Practice Address - Fax:850-807-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004565900Medicaid