MEDICARE: AVA ELISE WOOD

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	103K00000X	Behavior Analyst	BAC998889	VA

General Provider Information

NPI Number	:	1245161009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA ELISE WOOD

Provider Business Mailing Address
First Line	:	313 ELDEN STREET
Second Line	:	SUITE 302
City	:	HERNDON
State	:	VA
Zip	:	20170
Country	:	US
Telephone Number	:	703-496-4371
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 ELDEN STREET
Second Line	:	SUITE 302
City	:	HERNDON
State	:	VA
Zip	:	20170
Country	:	US
Telephone Number	:	703-496-4371
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ AVA ELISE WOOD ” Practice Location

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