Provider Demographics
NPI:1235418179
Name:WOOD, EMILY (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21578 LAWRENCE 1074
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-8268
Mailing Address - Country:US
Mailing Address - Phone:479-426-8003
Mailing Address - Fax:
Practice Address - Street 1:300 N MYRTLE ST
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723-1124
Practice Address - Country:US
Practice Address - Phone:417-476-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010013279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist