Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor |
NPI | 1033772405 |
---|---|
Provider Name | Jesse Willard Woods Iii |
First Address | Philadelphia, PA 19121-3870 |
Second Address | Philadelphia, PA 19121-3870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2019 |
Last Update Date | 03/04/2020 |