Provider Demographics
NPI:1427338573
Name:WOODSON, PELADIJA MARY (LISW)
Entity type:Individual
Prefix:MRS
First Name:PELADIJA
Middle Name:MARY
Last Name:WOODSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 DOUGLAS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5310
Mailing Address - Country:US
Mailing Address - Phone:319-440-0584
Mailing Address - Fax:
Practice Address - Street 1:3125 DOUGLAS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5365
Practice Address - Country:US
Practice Address - Phone:319-440-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health