Provider Demographics
NPI:1982228623
Name:WOOD, ISABELLA GRACE
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:GRACE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 STONEBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-6027
Mailing Address - Country:US
Mailing Address - Phone:931-881-5602
Mailing Address - Fax:
Practice Address - Street 1:5511 EDMONDSON PIKE STE 105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6852
Practice Address - Country:US
Practice Address - Phone:615-564-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician