Individual
MARTHA P WOODALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2 SOUTHERN POINTE PARKWAY, SUITE 200, HATTIESBURG, MS 39402
(601) 268-2615
(601) 268-2039
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5488
(601) 268-2039
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
66793
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07639097
—
MS
01
—
7845679
AETNA
MS
Enumeration date
08/30/2006
Last updated
06/24/2010
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