Provider Demographics
NPI:1386151223
Name:WOODS, JEWEL
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:WOODS
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 1:1298 CRYSTAL TREE CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8247
Mailing Address - Country:US
Mailing Address - Phone:216-224-5472
Mailing Address - Fax:
Practice Address - Street 1:1670 UPHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1250
Practice Address - Country:US
Practice Address - Phone:614-293-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0901507104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker