Provider Demographics
NPI:1811331879
Name:WOODWARD, JIMMIE SCOTT (MSW)
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:SCOTT
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1306
Mailing Address - Country:US
Mailing Address - Phone:734-934-7957
Mailing Address - Fax:
Practice Address - Street 1:408 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1306
Practice Address - Country:US
Practice Address - Phone:734-934-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085886104100000X
MI68011092181041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical