MEDICARE: KRISTEN 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	1041C0700X	Clinical Social Worker	1540-4036C	AL

General Provider Information

NPI Number	:	1699324780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN WOOD

Provider Business Mailing Address
First Line	:	4729 BANKHEAD CT
Second Line	:
City	:	IRONDALE
State	:	AL
Zip	:	35210-2403
Country	:	US
Telephone Number	:	205-527-8616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 3RD AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1628
Country	:	US
Telephone Number	:	205-635-6250
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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Directions to “ KRISTEN WOOD ” Practice Location

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