Provider Demographics
NPI:1295065225
Name:WOOD, WALTER A (ILLINOIS LICENSED HE)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:ILLINOIS LICENSED HE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 CENTER POINT ROAD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2944
Mailing Address - Country:US
Mailing Address - Phone:319-393-8994
Mailing Address - Fax:319-393-0895
Practice Address - Street 1:3717 CENTER POINT ROAD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2944
Practice Address - Country:US
Practice Address - Phone:319-393-8994
Practice Address - Fax:319-393-0895
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2948237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist