Provider Demographics
NPI:1740525070
Name:WOODHULL, JOANN MARIE (CSAC)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:MARIE
Last Name:WOODHULL
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:MS
Other - First Name:JOANN
Other - Middle Name:MARIE
Other - Last Name:BARYLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC,PSIT
Mailing Address - Street 1:53585 NOKOMIS RD
Mailing Address - Street 2:AODA OFFICE
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-4272
Mailing Address - Country:US
Mailing Address - Phone:715-682-7137
Mailing Address - Fax:715-685-7857
Practice Address - Street 1:53585 NOKOMIS RD
Practice Address - Street 2:AODA OFFICE
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-4272
Practice Address - Country:US
Practice Address - Phone:715-682-7137
Practice Address - Fax:715-685-7857
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15599-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)