Individual
DENNIS J WOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH D
Contact information
Practice address
1310 W HAYS STREET, BOISE, ID 83702
(208) 395-0041
(208) 343-4458
Mailing address
1310 W HAYS STREET, BOISE, ID 83702
(208) 395-0041
(208) 343-4458
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY276
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010016343
REGENCE BLUE SHIELD
ID
01
—
N2761
BLUE CROSS OF IDAHO
ID
Enumeration date
08/22/2006
Last updated
07/08/2007
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