Provider Demographics
NPI:1770135907
Name:WOOLRIDGE, ANTHONY DEON
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DEON
Last Name:WOOLRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2658
Mailing Address - Country:US
Mailing Address - Phone:740-851-5025
Mailing Address - Fax:
Practice Address - Street 1:39 S PAINT ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3211
Practice Address - Country:US
Practice Address - Phone:740-851-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator