Healthcare Provider Details

I. General information

NPI: 1740709294
Provider Name (Legal Business Name): SARAH JOY WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 08/20/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

IV. Provider business mailing address

1200 N 4TH ST
EFFINGHAM IL
62401-3032
US

V. Phone/Fax

Practice location:
  • Phone: 217-238-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014611
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: