Provider Demographics
NPI:1700614237
Name:WOODLAND, WILLIAM RUSSELL
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:WOODLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13433 ROOSEVELT WAY N APT 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7856
Mailing Address - Country:US
Mailing Address - Phone:206-769-2875
Mailing Address - Fax:
Practice Address - Street 1:8725 S 212TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1921
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician