Provider Demographics
NPI:1902304215
Name:WOODWARD, ERICA LEANN
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEANN
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEANN
Other - Last Name:STREVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6315 MUTUAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4238
Mailing Address - Country:US
Mailing Address - Phone:260-833-7474
Mailing Address - Fax:
Practice Address - Street 1:6315 MUTUAL DR STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4238
Practice Address - Country:US
Practice Address - Phone:260-833-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34009071A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker