Provider Demographics
NPI:1346556065
Name:WOOD, REBECCA ELLEN (AUD CCCA FAAA)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELLEN
Last Name:WOOD
Suffix:
Gender:F
Credentials:AUD CCCA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5926
Mailing Address - Country:US
Mailing Address - Phone:309-688-4327
Mailing Address - Fax:309-688-6846
Practice Address - Street 1:4704 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5926
Practice Address - Country:US
Practice Address - Phone:309-688-4327
Practice Address - Fax:309-688-6846
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000280237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1033216395OtherNPI TYPE 2 BUSINESS IDENTIFIER