Individual
LISA WOODGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21419 W DOVE VALLEY RD, WITTMANN, AZ 85361
(623) 388-2321
Mailing address
22850 W SIERRA RIDGE WAY, WITTMANN, AZ 85361-8785
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
SA 633
FL
235Z00000X
Speech-Language Pathologist
Primary
SLP2110
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
814485
—
AZ
Enumeration date
01/16/2007
Last updated
07/09/2007
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