Provider Demographics
NPI:1265984264
Name:WOOD, JULIE ELAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ELAINE
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ELAINE
Other - Last Name:SHUMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1075 SE 36TH AVE
Mailing Address - Street 2:HILLSBORO
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7709
Mailing Address - Country:US
Mailing Address - Phone:503-640-4160
Mailing Address - Fax:971-371-2141
Practice Address - Street 1:1075 SE 36TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7709
Practice Address - Country:US
Practice Address - Phone:503-640-4160
Practice Address - Fax:971-371-2141
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical