Provider Demographics
NPI:1457603615
Name:WOODHOUSE, MAXINE ALYCIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:ALYCIA
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17270 HIGHLAND AVE APT 7T
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2802
Mailing Address - Country:US
Mailing Address - Phone:214-909-8469
Mailing Address - Fax:
Practice Address - Street 1:17270 HIGHLAND AVE APT 7T
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2802
Practice Address - Country:US
Practice Address - Phone:214-909-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist