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General NPI Number Information
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NPI Number | 1497933543
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Entity Type | Individual
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Provider Name | NICOLE WOOD MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 10820 SUNSET OFFICE DR SUITE 108
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1016
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Country | US
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Telephone | 314-956-9869
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N 38TH ST
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City | BELLEVILLE
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State | IL
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Zip | 62226-6024
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Country | US
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Telephone | 618-443-8023
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2007034751
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License Number State | MO
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