Provider Demographics
NPI:1386845485
Name:WOOD, KENNETH S
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4437
Mailing Address - Country:US
Mailing Address - Phone:530-749-9734
Mailing Address - Fax:530-751-3992
Practice Address - Street 1:747 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4437
Practice Address - Country:US
Practice Address - Phone:530-749-9734
Practice Address - Fax:530-751-3992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH.A. 6032237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist