Provider Demographics
NPI:1912362120
Name:WOODWARD CORE, KELLY (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WOODWARD CORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 TEKOA DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-7900
Mailing Address - Country:US
Mailing Address - Phone:509-851-1678
Mailing Address - Fax:
Practice Address - Street 1:515 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3737
Practice Address - Country:US
Practice Address - Phone:509-543-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health