Provider Demographics
NPI:1396431219
Name:WOODWARD, MICHELLE (LICSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46621 CEDAR BEAU RD
Mailing Address - Street 2:
Mailing Address - City:LOON LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99148-5110
Mailing Address - Country:US
Mailing Address - Phone:509-224-8554
Mailing Address - Fax:
Practice Address - Street 1:46621 CEDAR BEAU RD
Practice Address - Street 2:
Practice Address - City:LOON LAKE
Practice Address - State:WA
Practice Address - Zip Code:99148-5110
Practice Address - Country:US
Practice Address - Phone:509-224-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWI.LW.614891461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical