Healthcare Provider Details

I. General information

NPI: 1245687086
Provider Name (Legal Business Name): JOAN I WOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 N ARLINGTON HEIGHTS RD SUITE #304
ARLINGTON HEIGHTS IL
60004-3982
US

IV. Provider business mailing address

1655 N ARLINGTON HEIGHTS RD SUITE #304
ARLINGTON HEIGHTS IL
60004-3982
US

V. Phone/Fax

Practice location:
  • Phone: 847-670-0880
  • Fax: 847-670-1268
Mailing address:
  • Phone: 847-670-0880
  • Fax: 847-670-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071003761
License Number StateIL

VIII. Authorized Official

Name: JOAN I WOOD
Title or Position: OWNER
Credential: PHD
Phone: 847-670-0880