Provider Demographics
NPI:1518346816
Name:WOOD, DAVID W (AUD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:WOOD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4719
Mailing Address - Country:US
Mailing Address - Phone:208-746-4100
Mailing Address - Fax:208-883-5667
Practice Address - Street 1:2840 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4719
Practice Address - Country:US
Practice Address - Phone:208-746-4100
Practice Address - Fax:208-883-5667
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-2835237600000X
OR030823231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter