Provider Demographics
NPI:1609355718
Name:WOOD, ASHLEY M (PSYD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W BROMPTON AVE UNIT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1830
Mailing Address - Country:US
Mailing Address - Phone:703-203-0875
Mailing Address - Fax:
Practice Address - Street 1:500 N MICHIGAN AVE STE 1520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3758
Practice Address - Country:US
Practice Address - Phone:312-283-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical