Provider Demographics
NPI:1144975053
Name:WOOD, JENNIFER RUTH
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 REDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8590
Mailing Address - Country:US
Mailing Address - Phone:435-633-5368
Mailing Address - Fax:
Practice Address - Street 1:87 N 200 E STE 302
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5019
Practice Address - Country:US
Practice Address - Phone:435-922-2750
Practice Address - Fax:435-922-2759
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YA0400X, 101YM0800X
171M00000X
UTACM-00279171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health