Provider Demographics
NPI:1205142825
Name:WOODARD, MATTHEW J (MED, BCBA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:WOODARD
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-2503
Mailing Address - Country:US
Mailing Address - Phone:360-280-4414
Mailing Address - Fax:360-547-6470
Practice Address - Street 1:320 6TH ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-2503
Practice Address - Country:US
Practice Address - Phone:360-280-4414
Practice Address - Fax:360-547-6470
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10017103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst