Provider Demographics
NPI:1780673186
Name:WOODWARD, JODY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:LYNN
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1976 PICKFAIR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3628
Mailing Address - Country:US
Mailing Address - Phone:636-288-9631
Mailing Address - Fax:877-842-8918
Practice Address - Street 1:14561 N OUTER 40 RD
Practice Address - Street 2:STE 250
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5703
Practice Address - Country:US
Practice Address - Phone:636-288-9631
Practice Address - Fax:877-842-8918
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005005795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO197560OtherBCBS MISSOURI
MO497215111Medicaid
MO797676000OtherMAGELLAN
MO000021966Medicare ID - Type Unspecified