Provider Demographics
NPI:1598068207
Name:WOOD, COURTNEY (MED, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:WOOD-HARVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, CCC/SLP
Mailing Address - Street 1:3120 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-2865
Mailing Address - Country:US
Mailing Address - Phone:772-485-6686
Mailing Address - Fax:
Practice Address - Street 1:3120 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2865
Practice Address - Country:US
Practice Address - Phone:772-485-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist