Provider Demographics
NPI:1912209651
Name:WOOD, LISA MARIE (HAD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4237
Mailing Address - Country:US
Mailing Address - Phone:800-323-3277
Mailing Address - Fax:
Practice Address - Street 1:415 EAST CITRUS AVE.
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5218
Practice Address - Country:US
Practice Address - Phone:909-793-2631
Practice Address - Fax:909-792-2413
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2878237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist