Provider Demographics
NPI:1417561259
Name:WOODLOCK, SARAH ELAINE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELAINE
Last Name:WOODLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BARNARD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3150
Mailing Address - Country:US
Mailing Address - Phone:304-636-4343
Mailing Address - Fax:304-636-4330
Practice Address - Street 1:60 BARNARD AVE STE 1
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3150
Practice Address - Country:US
Practice Address - Phone:304-636-4343
Practice Address - Fax:304-636-4330
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator