Provider Demographics
NPI:1942241500
Name:WOOD, KATHERINE C (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:C
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4834
Mailing Address - Country:US
Mailing Address - Phone:847-636-8704
Mailing Address - Fax:
Practice Address - Street 1:1600 GOLF RD STE 1200
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4229
Practice Address - Country:US
Practice Address - Phone:847-636-8704
Practice Address - Fax:847-692-2993
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005574103TC0700X
IL071005574103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209611Medicare PIN
ILL89883Medicare PIN