Provider Demographics
NPI:1689256976
Name:WOODARD, LEONARD JADON (RBT)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:JADON
Last Name:WOODARD
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3824 BUELL ST STE A2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2861
Mailing Address - Country:US
Mailing Address - Phone:510-422-3959
Mailing Address - Fax:
Practice Address - Street 1:3824 BUELL ST STE A2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2861
Practice Address - Country:US
Practice Address - Phone:510-422-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician