Healthcare Provider Details

I. General information

NPI: 1134571771
Provider Name (Legal Business Name): JULIA ANNE WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6759 N RAVENSWOOD AVE
CHICAGO IL
60626-3928
US

IV. Provider business mailing address

5712 CHRIS LN
CRYSTAL LAKE IL
60014-4660
US

V. Phone/Fax

Practice location:
  • Phone: 773-301-5257
  • Fax: 773-761-6532
Mailing address:
  • Phone: 847-354-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number217.000071
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: