Provider Demographics
NPI:1992937288
Name:WOODS, JUDY (PHD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45115 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-5215
Mailing Address - Country:US
Mailing Address - Phone:507-450-7104
Mailing Address - Fax:
Practice Address - Street 1:50 W 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3440
Practice Address - Country:US
Practice Address - Phone:507-450-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MNLP5563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional