Provider Demographics
NPI:1982817615
Name:WOODARDS, JERRY (MSW)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:WOODARDS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-5388
Mailing Address - Country:US
Mailing Address - Phone:360-977-4133
Mailing Address - Fax:360-597-4234
Practice Address - Street 1:2100 NE BROADWAY ST
Practice Address - Street 2:STE 335
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1570
Practice Address - Country:US
Practice Address - Phone:360-977-4133
Practice Address - Fax:360-597-4234
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00037066101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor