Provider Demographics
NPI:1992376198
Name:WOODSON, KELLI (PSYD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:WOODSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2433
Mailing Address - Country:US
Mailing Address - Phone:603-614-5324
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2433
Practice Address - Country:US
Practice Address - Phone:603-614-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical