Provider Demographics
NPI:1629780523
Name:WOOD, WILLIAM SANBORN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SANBORN
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 N LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9547
Mailing Address - Country:US
Mailing Address - Phone:989-600-9820
Mailing Address - Fax:
Practice Address - Street 1:3710 KATALIN CT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2160
Practice Address - Country:US
Practice Address - Phone:989-324-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician