Provider Demographics
NPI:1790307072
Name:WOODALL, DAVID ANDREW (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:WOODALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 E KEMPER RD STE 4220A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-5100
Mailing Address - Country:US
Mailing Address - Phone:513-570-4506
Mailing Address - Fax:
Practice Address - Street 1:1329 E KEMPER RD STE 4220A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-5100
Practice Address - Country:US
Practice Address - Phone:513-570-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096649103TC0700X
OHP.08029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405471Medicaid