1265984264 NPI number — MS. JULIE ELAINE WOOD LCSW

Table of content: MS. JULIE ELAINE WOOD LCSW (NPI 1265984264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265984264 NPI number — MS. JULIE ELAINE WOOD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
JULIE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHUMAKER
Provider Other First Name:
JULIE
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265984264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075 SE 36TH AVE
Provider Second Line Business Mailing Address:
HILLSBORO
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97123-7709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-640-4160
Provider Business Mailing Address Fax Number:
971-371-2141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 SE 36TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-7709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-640-4160
Provider Business Practice Location Address Fax Number:
971-371-2141
Provider Enumeration Date:
10/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1052 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)