Provider Demographics
NPI:1891087730
Name:WOOD, JON S
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:S
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 1:6 VICTORY DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2395
Mailing Address - Country:US
Mailing Address - Phone:816-313-2800
Mailing Address - Fax:816-792-9819
Practice Address - Street 1:2718 FORUM BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5451
Practice Address - Country:US
Practice Address - Phone:573-256-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000939237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008000939OtherHEARING INSTRUMENT SPECIALIST