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General NPI Number Information
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NPI Number | 1053821736
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Entity Type | Individual
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Provider Name | KAILEY A WOOD PSS
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Gender | Female
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 11719 NE 95TH ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98682-2444
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Country | US
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Telephone | 503-490-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 11719 NE 95TH ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98682-2444
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Country | US
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Telephone | 503-490-2292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | PHW2019
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | THW2019
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CG61009839
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License Number State | WA
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