Individual
JACK WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSW
Contact information
Practice address
3900 W BROWN DEER RD STE 200, BROWN DEER, WI 53209-1220
(414) 540-2170
Mailing address
1390 GREENWAY TER APT 2, BROOKFIELD, WI 53005-6913
(262) 957-4138
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42244700
—
WI
Enumeration date
10/22/2007
Last updated
10/22/2007
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