Provider Demographics
NPI:1902954548
Name:WOODARD, WENDY J (PSYD, ABDA)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:J
Last Name:WOODARD
Suffix:
Gender:F
Credentials:PSYD, ABDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4121
Mailing Address - Country:US
Mailing Address - Phone:206-528-5671
Mailing Address - Fax:
Practice Address - Street 1:5122 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4121
Practice Address - Country:US
Practice Address - Phone:206-528-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY12341980103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist