Healthcare Provider Details

I. General information

NPI: 1215162011
Provider Name (Legal Business Name): MARGARET LOUISE WOOD MS/CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 ACEQUIA BORRADA W
SANTA FE NM
87507-7157
US

IV. Provider business mailing address

1420 ACEQUIA BORRADA
SANTA FE NM
87507-7157
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-1457
  • Fax:
Mailing address:
  • Phone: 505-424-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: