| Woollard Ipsen Managment Llc | |
|
832 E Main St Medford OR 97504-7153 | |
| (541) 773-2771 | |
| (541) 773-2808 |
| Full Name | Woollard Ipsen Managment Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 832 E Main St, Medford, Oregon |
| Authorized Official Name and Position | Todd Monroe Woollard (MANAGING MEMBER) |
| Authorized Official Contact | 5417732771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Woollard Ipsen Managment Llc 832 E Main St Medford OR 97504-7153 Ph: (541) 773-2771 | Woollard Ipsen Managment Llc 832 E Main St Medford OR 97504-7153 Ph: (541) 773-2771 |
| NPI Number | 1528684255 |
|---|---|
| Provider Enumeration Date | 06/18/2020 |
| Last Update Date | 06/18/2020 |
| Certification Date | 06/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528684255 | NPI | - | NPPES |
| 733254 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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