Provider Demographics
NPI:1104525112
Name:WOOD, JERRY (CHES)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 REPUBLICAN ST BLDG C FLR 2 BOX : 358051
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-520-5584
Mailing Address - Fax:206-520-4747
Practice Address - Street 1:850 REPUBLICAN ST BLDG C FLR 2 BOX : 358051
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-520-5584
Practice Address - Fax:206-520-4747
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37796171400000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach