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General NPI Number Information
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NPI Number | 1902454978
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Entity Type | Individual
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Provider Name | DIANA WOOD
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 200 MEDICAL CENTER DR
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City | HARLAN
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State | KY
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Zip | 40831-0014
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Country | US
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Telephone | 606-573-7250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 883
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City | WALLINS CREEK
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State | KY
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Zip | 40873-0883
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Country | US
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Telephone | 606-273-0912
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 136867
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License Number State | KY
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