Healthcare Provider Details

I. General information

NPI: 1194651026
Provider Name (Legal Business Name): MYA LYNN WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21701 76TH AVE W STE 301
EDMONDS WA
98026-7500
US

IV. Provider business mailing address

1027 BOLLES RD
WAITSBURG WA
99361-9662
US

V. Phone/Fax

Practice location:
  • Phone: 425-230-4858
  • Fax:
Mailing address:
  • Phone: 509-737-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70149632
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: