Provider Demographics
NPI:1942257563
Name:WOOD, MARIE WISEMAN (PHD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:WISEMAN
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 1:324 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6647
Mailing Address - Country:US
Mailing Address - Phone:479-986-0566
Mailing Address - Fax:479-986-0599
Practice Address - Street 1:324 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6647
Practice Address - Country:US
Practice Address - Phone:479-986-0566
Practice Address - Fax:479-986-0599
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-01P103TC0700X
TX33129103TC0700X
UT95-308788-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical