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General NPI Number Information
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NPI Number | 1003438086
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Entity Type | Organization
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Legal Business Name | MARIE W. WOOD PHD INC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 215 N EAST AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5296
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Country | US
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Telephone | 479-521-9696
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4808
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City | FAYETTEVILLE
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State | AR
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Zip | 72702-4808
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Country | US
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Telephone | 479-236-3221
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TERRY BORMAN
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Credential |
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Telephone | 479-236-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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