MEDICARE: MS. HOLLY E. WOOD MSW, LISW-S

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	1041C0700X	Clinical Social Worker	I-5786 SUPV	OH

General Provider Information

NPI Number	:	1366974636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY E. WOOD MSW, LISW-S

Provider Business Mailing Address
First Line	:	285 ILLINOIS AVE
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2357
Country	:	US
Telephone Number	:	614-558-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 E WILSON BRIDGE RD STE C2
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2362
Country	:	US
Telephone Number	:	614-558-1991
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	03/31/2022

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