Provider Demographics
NPI:1336536523
Name:WOODWORTH, JODIE ANN (LLMSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ANN
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ANN
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:15123 MURRAY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MI
Mailing Address - Zip Code:48418-9053
Mailing Address - Country:US
Mailing Address - Phone:859-339-4707
Mailing Address - Fax:
Practice Address - Street 1:15123 MURRAY WOODS CT
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MI
Practice Address - Zip Code:48418-9053
Practice Address - Country:US
Practice Address - Phone:859-339-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI68010971551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)