Woodworth, Dina Breanne Maxine
Woodworth, Dina Breanne Maxine is an individual health care provider with primary practice located at 634 N Main St , O Fallon IL 62269-3751. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Woodworth, Dina Breanne Maxine can be contacted via phone (618) 726-0701.Contact Information
Primary practice address
634 N Main St
O Fallon IL 62269-3751
Phone: (618) 726-0701
Fax: (224) 210-1514
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X | W363-1629-3972 | Illinois |
Profile Details
| NPI number | 1053955906 |
|---|---|
| LBN Legal business name | Woodworth, Dina Breanne Maxine |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 4th, 2019 |
| Last updated | Nov 4th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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