Provider Demographics
NPI:1700376142
Name:WOFFORD, MARY CLAIRE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:WOFFORD
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 1:707 TRUETT DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5222
Mailing Address - Country:US
Mailing Address - Phone:336-403-0462
Mailing Address - Fax:
Practice Address - Street 1:101 N MADISON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2410
Practice Address - Country:US
Practice Address - Phone:850-566-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist