Provider Demographics
NPI:1992547376
Name:MARY JOAN WOOD SPEECH PATHOLOGY
Entity type:Organization
Organization Name:MARY JOAN WOOD SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MHS,CCC-SLP
Authorized Official - Phone:660-988-1293
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:MO
Mailing Address - Zip Code:65239-0115
Mailing Address - Country:US
Mailing Address - Phone:660-988-1293
Mailing Address - Fax:
Practice Address - Street 1:501 W SHORE DR
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:MO
Practice Address - Zip Code:65239-2012
Practice Address - Country:US
Practice Address - Phone:660-988-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty