MEDICARE: DR. MARCIA JOHNSTON WOOD PH.D.

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	103T00000X	Psychologist	1060	OR

General Provider Information

NPI Number	:	1881791226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCIA JOHNSTON WOOD PH.D.

Provider Business Mailing Address
First Line	:	5441 SW MACADAM, SUITE104
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3821
Country	:	US
Telephone Number	:	503-248-4511
Fax Number	:	503-248-6385

Provider Business Practice Location Address
First Line	:	5441 SW MACADAM, SUITE104
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3821
Country	:	US
Telephone Number	:	503-248-4511
Fax Number	:	503-248-6385

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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