MEDICARE: SHELLY J WOOD LMSW

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	6801046513	MI

General Provider Information

NPI Number	:	1578796272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY J WOOD LMSW

Provider Business Mailing Address
First Line	:	217 S MADISON ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2321
Country	:	US
Telephone Number	:	231-392-8400
Fax Number	:	231-392-8467

Provider Business Practice Location Address
First Line	:	217 S MADISON ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2321
Country	:	US
Telephone Number	:	231-392-8400
Fax Number	:	231-392-8467

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

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	07/19/2022

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