Individual
MICAH WOODARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
3750 CHEMAWA RD NE, SALEM, OR 97305-1119
(503) 390-4714
Mailing address
3750 CHEMAWA RD NE, SALEM, OR 97305-1119
(503) 390-4714
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60145757
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LW60145757
LICENSED CLINICAL SOCIAL WORKER
WA
Enumeration date
10/28/2010
Last updated
10/28/2010
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