Provider Demographics
NPI:1619211497
Name:WOOD, HEIDI S (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:S
Other - Last Name:SKINDINGSRUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CSAC
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1005
Mailing Address - Country:US
Mailing Address - Phone:262-741-3200
Mailing Address - Fax:262-741-3217
Practice Address - Street 1:W4051 COUNTY ROAD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4338
Practice Address - Country:US
Practice Address - Phone:262-741-3200
Practice Address - Fax:262-741-3217
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5374-125104100000X
WI15801-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)