Provider Demographics
NPI:1639551062
Name:WOOD, JENNEA (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNEA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7244 SE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4146
Mailing Address - Country:US
Mailing Address - Phone:541-914-7888
Mailing Address - Fax:
Practice Address - Street 1:1703 5TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1826
Practice Address - Country:US
Practice Address - Phone:971-200-5212
Practice Address - Fax:844-228-9534
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2093175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath