Provider Demographics
NPI:1851056519
Name:WOODS, BECKY E
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:E
Last Name:WOODS
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 1:204 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3123
Mailing Address - Country:US
Mailing Address - Phone:779-212-2671
Mailing Address - Fax:
Practice Address - Street 1:204 JOHN ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3123
Practice Address - Country:US
Practice Address - Phone:779-212-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker