Provider Demographics
NPI:1275187528
Name:WOOD, AILENE
Entity Type:Individual
Prefix:
First Name:AILENE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 E CAMPUS DR STE H
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4514
Mailing Address - Country:US
Mailing Address - Phone:801-789-7780
Mailing Address - Fax:801-789-7700
Practice Address - Street 1:3726 E CAMPUS DR STE H
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-4514
Practice Address - Country:US
Practice Address - Phone:801-789-7780
Practice Address - Fax:801-789-7700
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist