Provider Demographics
NPI:1144666033
Name:WOOD, JENNIFER LYNNE (BCABA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:WOOD
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HOLLIS RD
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040-7759
Mailing Address - Country:US
Mailing Address - Phone:828-242-2807
Mailing Address - Fax:
Practice Address - Street 1:555 HOLLIS RD
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:NC
Practice Address - Zip Code:28040-7759
Practice Address - Country:US
Practice Address - Phone:828-242-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0114304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst