Provider Demographics
NPI:1154140887
Name:WOOD, JORDANNA (LEP)
Entity type:Individual
Prefix:
First Name:JORDANNA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 HUDIS ST
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1445
Mailing Address - Country:US
Mailing Address - Phone:707-782-6689
Mailing Address - Fax:
Practice Address - Street 1:825 HUDIS ST
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1445
Practice Address - Country:US
Practice Address - Phone:707-588-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3992103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool