Provider Demographics
NPI:1467121103
Name:WOOD, WENDY ELIZABETH (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ELIZABETH
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CRICKET HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4222
Mailing Address - Country:US
Mailing Address - Phone:512-573-9884
Mailing Address - Fax:
Practice Address - Street 1:1311 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4941
Practice Address - Country:US
Practice Address - Phone:512-464-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist