MEDICARE: LISA JO 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	101Y00000X	Counselor		OR

General Provider Information

NPI Number	:	1396613386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JO WOOD

Provider Business Mailing Address
First Line	:	10017 NE 13TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-1563
Country	:	US
Telephone Number	:	541-806-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	10017 NE 13TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-1563
Country	:	US
Telephone Number	:	541-806-0341
Fax Number	:

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

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	10/29/2025

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Directions to “ LISA JO WOOD ” Practice Location

Language	Start Address	Practice Location

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