Provider Demographics
NPI:1467412932
Name:WOOD, FELICIA HELENE (CSW)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:HELENE
Last Name:WOOD
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900245
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-0245
Mailing Address - Country:US
Mailing Address - Phone:801-634-8727
Mailing Address - Fax:801-733-4083
Practice Address - Street 1:50 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2139
Practice Address - Country:US
Practice Address - Phone:801-647-9190
Practice Address - Fax:801-733-4083
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6019548-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical