Provider Demographics
NPI:1104854538
Name:WOOD, PAMELA R (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 N SWAN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4042
Mailing Address - Country:US
Mailing Address - Phone:520-325-8899
Mailing Address - Fax:520-325-0699
Practice Address - Street 1:1661 N SWAN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4042
Practice Address - Country:US
Practice Address - Phone:520-325-8899
Practice Address - Fax:520-325-0699
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA536231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0303040OtherBLUE CROSS/BLUE SHIELD
AZP00243100OtherRAILROAD MEDICARE
AZAZ0303040OtherBLUE CROSS/BLUE SHIELD