Provider Demographics
NPI:1710543038
Name:WOOD, AMY FLANAGAN (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FLANAGAN
Last Name:WOOD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1926
Mailing Address - Country:US
Mailing Address - Phone:718-809-4836
Mailing Address - Fax:
Practice Address - Street 1:715 LAKE ST STE 517B
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1414
Practice Address - Country:US
Practice Address - Phone:872-395-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist