Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 20042068A | IN |
N | 103T00000X | Psychologist | 20042068A | IN |
N | 102L00000X | Psychologist | P.07823 | OH |
N | 103T00000X | Psychologist | P.07823 | OH |
Y | 103TH0100X | Health Service | 20042068B | IN |
NPI | 1174740252 |
---|---|
Provider Name | Michael Woodin |
First Address | Richmond, IN 47374 |
Second Address | Richmond, IN 47374-1913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 27/09/2021 |