Provider Demographics
NPI:1982431581
Name:WOODWARD, BONNIE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:WOODWARD
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 1:1000 HILLTOP CIRCLE PSYCHOLOGY DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21250-0001
Mailing Address - Country:US
Mailing Address - Phone:410-455-3705
Mailing Address - Fax:
Practice Address - Street 1:1450 S ROLLING RD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3863
Practice Address - Country:US
Practice Address - Phone:410-455-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program