Provider Demographics
NPI:1447524541
Name:WOODRUFF, JESSICA MARIE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:WOODRUFF
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 1:5701 W TALAVI BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1886
Mailing Address - Country:US
Mailing Address - Phone:623-486-8202
Mailing Address - Fax:623-486-2739
Practice Address - Street 1:4747 N 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3653
Practice Address - Country:US
Practice Address - Phone:602-279-7655
Practice Address - Fax:602-264-1806
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health