Provider Demographics
NPI:1659637759
Name:WOOD, HEIDI JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:JO
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9650
Mailing Address - Country:US
Mailing Address - Phone:225-926-7500
Mailing Address - Fax:225-924-0188
Practice Address - Street 1:4611 BLUEBONNET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9650
Practice Address - Country:US
Practice Address - Phone:225-926-7500
Practice Address - Fax:225-924-0188
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA65531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical