Provider Demographics
NPI:1851038483
Name:WOODLEY, EBONY LESTRICE
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:LESTRICE
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:LESTRICE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 GAMBELL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4664
Mailing Address - Country:US
Mailing Address - Phone:907-333-4343
Mailing Address - Fax:907-333-4383
Practice Address - Street 1:1231 GAMBELL ST STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4664
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:907-333-4383
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator