Provider Demographics
NPI:1912349044
Name:WOODARD, AMY MARIE
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:GERWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13545 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8303
Mailing Address - Country:US
Mailing Address - Phone:760-243-5922
Mailing Address - Fax:
Practice Address - Street 1:13901 AMARGOSA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2409
Practice Address - Country:US
Practice Address - Phone:760-512-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst