Healthcare Provider Details

I. General information

NPI: 1861015414
Provider Name (Legal Business Name): THOMAS J WOOD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E ROBIN WAY APT I
APPLETON WI
54915-4245
US

IV. Provider business mailing address

1800 E ROBIN WAY APT I
APPLETON WI
54915-4245
US

V. Phone/Fax

Practice location:
  • Phone: 262-444-5255
  • Fax:
Mailing address:
  • Phone: 262-444-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number461-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: