Provider Demographics
NPI:1376432070
Name:WOODALL, SOPHIA ANN (RBT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANN
Last Name:WOODALL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 W STATE ROAD 56
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47567-8558
Mailing Address - Country:US
Mailing Address - Phone:812-582-2865
Mailing Address - Fax:812-582-2865
Practice Address - Street 1:401 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:IN
Practice Address - Zip Code:47598-5446
Practice Address - Country:US
Practice Address - Phone:812-582-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician