Provider Demographics
NPI:1255041158
Name:WOODARD, ALBERT JAMES III (SWT)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:JAMES
Last Name:WOODARD
Suffix:III
Gender:M
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17608 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1216
Mailing Address - Country:US
Mailing Address - Phone:216-417-6166
Mailing Address - Fax:
Practice Address - Street 1:17608 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1216
Practice Address - Country:US
Practice Address - Phone:216-417-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator