Provider Demographics
NPI:1295054534
Name:WOOD, SHIRLEY RAY (BC-HIS)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:RAY
Last Name:WOOD
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 W AMADOR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-4005
Mailing Address - Country:US
Mailing Address - Phone:575-647-2107
Mailing Address - Fax:575-521-1775
Practice Address - Street 1:1595 W AMADOR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-4005
Practice Address - Country:US
Practice Address - Phone:575-647-2107
Practice Address - Fax:575-521-1775
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0710237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0710OtherLICENSE