Provider Demographics
NPI:1689702367
Name:WOOD, MARGARET ELLEN (SLP CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ELLEN
Last Name:WOOD
Suffix:
Gender:F
Credentials:SLP CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 BOSQUE DEL SOL LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3154
Mailing Address - Country:US
Mailing Address - Phone:505-891-8473
Mailing Address - Fax:
Practice Address - Street 1:3100 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-891-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT7475Medicaid