MEDICARE: MR. SHAWN A. WOOD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LCSW-25510	ID

General Provider Information

NPI Number	:	1821201559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN A. WOOD LCSW

Provider Business Mailing Address
First Line	:	7655 E WOLF CREEK RD
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-9391
Country	:	US
Telephone Number	:	907-406-3830
Fax Number	:

Provider Business Practice Location Address
First Line	:	BUILDING TMD 05/06 FT. RICHARDSON
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99505
Country	:	US
Telephone Number	:	907-384-0830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	09/14/2016

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