Zackary Douglas Woodard

Key facts

NPI

1043935877

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

Practice address

120 Stevens St SW
Grand Rapids, MI 49507-1526

Phone

(616) 469-3870

NPI assigned

Oct 4, 2022

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 5, 2022.

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1043935877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5769 PETTIS CT NE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493018226",
            "telephone_number": "269-924-6114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 STEVENS ST SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495071526",
            "telephone_number": "616-469-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODARD",
        "first_name": "ZACKARY",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Taylor M Wood
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All providers in Grand Rapids, MI · Behavior Technician in Michigan