Provider Demographics
NPI:1417174020
Name:WOOD, JOE D JR (PSYD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:D
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DR
Mailing Address - Street 2:SUITE 261
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4648
Mailing Address - Country:US
Mailing Address - Phone:503-329-9195
Mailing Address - Fax:503-521-1593
Practice Address - Street 1:11160 SW WOOD DUCK PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8295
Practice Address - Country:US
Practice Address - Phone:503-329-9195
Practice Address - Fax:503-521-1593
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical