Basic Information
| Provider Information | |||||||||
| NPI: | 1831374412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODSON | ||||||||
| FirstName: | JANICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1566 ROSEWOOD TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630218464 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3009 N BALLAS RD | ||||||||
| Address2: | SUITE 100B | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144326308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2001010072 | MO | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.