Provider Demographics
NPI:1699274175
Name:WOODFORD, LEE LUCAS
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:LUCAS
Last Name:WOODFORD
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 1:1563 SHILOH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-4315
Mailing Address - Country:US
Mailing Address - Phone:434-591-1209
Mailing Address - Fax:
Practice Address - Street 1:14455 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-4136
Practice Address - Country:US
Practice Address - Phone:434-589-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist