MEDICARE: JEREMIAH 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	101YP2500X	Professional Counselor	CC00705	MN

General Provider Information

NPI Number	:	1285057612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH WOOD

Provider Business Mailing Address
First Line	:	2708 119TH AVE NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55433-2912
Country	:	US
Telephone Number	:	763-862-7944
Fax Number	:	763-767-1077

Provider Business Practice Location Address
First Line	:	2708 119TH AVE NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55433-2912
Country	:	US
Telephone Number	:	763-862-7944
Fax Number	:	763-767-1077

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

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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Directions to “ JEREMIAH WOOD ” Practice Location

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