Provider Demographics
NPI:1245859370
Name:WOOD, SUSAN VERONICA
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VERONICA
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 1:1010 PEACOCK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-2837
Mailing Address - Country:US
Mailing Address - Phone:513-306-3085
Mailing Address - Fax:
Practice Address - Street 1:1010 PEACOCK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2837
Practice Address - Country:US
Practice Address - Phone:513-306-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health