Provider Demographics
NPI:1275690513
Name:WOOD, ROXIE LEE (QMHA)
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:LEE
Last Name:WOOD
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RICKREALL
Mailing Address - State:OR
Mailing Address - Zip Code:97371-9739
Mailing Address - Country:US
Mailing Address - Phone:503-831-3230
Mailing Address - Fax:
Practice Address - Street 1:780 COMMERCIAL ST SE
Practice Address - Street 2:STE 304
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3462
Practice Address - Country:US
Practice Address - Phone:503-365-0045
Practice Address - Fax:503-365-9590
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator