Provider Demographics
NPI:1295853919
Name:WOOD, LYNN ANN (MACCCAUD CERTAVT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MACCCAUD CERTAVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N741 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-1712
Mailing Address - Country:US
Mailing Address - Phone:630-682-4051
Mailing Address - Fax:630-682-4051
Practice Address - Street 1:0N741 WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-1712
Practice Address - Country:US
Practice Address - Phone:630-682-4051
Practice Address - Fax:630-682-4051
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist