Provider Demographics
NPI:1932662384
Name:WOOLRIDGE, JODIE
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:WOOLRIDGE
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 1:8814 WHITE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-1118
Mailing Address - Country:US
Mailing Address - Phone:248-600-7330
Mailing Address - Fax:
Practice Address - Street 1:37550 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3099
Practice Address - Country:US
Practice Address - Phone:248-600-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care