Provider Demographics
NPI:1700253424
Name:JENNEA R WOOD
Entity Type:Organization
Organization Name:JENNEA R WOOD
Other - Org Name:ARALIA NATURAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-914-7888
Mailing Address - Street 1:7244 SE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4146
Mailing Address - Country:US
Mailing Address - Phone:541-914-7888
Mailing Address - Fax:
Practice Address - Street 1:1703 5TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1826
Practice Address - Country:US
Practice Address - Phone:541-914-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2093175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty