Healthcare Provider Details

I. General information

NPI: 1346556065
Provider Name (Legal Business Name): REBECCA ELLEN WOOD AU.D. CCCA FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 N SHERIDAN RD
PEORIA IL
61614-5926
US

IV. Provider business mailing address

4704 N SHERIDAN RD
PEORIA IL
61614-5926
US

V. Phone/Fax

Practice location:
  • Phone: 309-688-4327
  • Fax: 309-688-6846
Mailing address:
  • Phone: 309-688-4327
  • Fax: 309-688-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147000280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: