Provider Demographics
NPI:1841961646
Name:WOODS, KAYLIE
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 60TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2369
Mailing Address - Country:US
Mailing Address - Phone:510-701-9534
Mailing Address - Fax:
Practice Address - Street 1:954 60TH ST STE 10
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2369
Practice Address - Country:US
Practice Address - Phone:510-701-9534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0136OtherMHAAC