MEDICARE: TERI JEAN WOOD CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1235641218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI JEAN WOOD CCC-SLP

Provider Business Mailing Address
First Line	:	1375 COUNTY ROAD 1111
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-5805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 WESTPORT PKWY STE 1300
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-5316
Country	:	US
Telephone Number	:	817-823-4694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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Directions to “ TERI JEAN WOOD CCC-SLP” Practice Location

Language	Start Address	Practice Location

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