Provider Demographics
NPI:1760995153
Name:WOODARD, JENNIFER HOLLY (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOLLY
Last Name:WOODARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1707
Mailing Address - Country:US
Mailing Address - Phone:970-443-5016
Mailing Address - Fax:
Practice Address - Street 1:1530 FREEDOM LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1707
Practice Address - Country:US
Practice Address - Phone:970-443-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty