Kailey A Wood, PSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

CG61009839 Issued in WA

Practice address

11719 NE 95TH St Ste a
Vancouver, WA 98682-2444

Phone

(503) 490-2292

NPI assigned

Oct 6, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kailey.wood.p2@direct.lanecounty.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifeline Connections

  • Substance Abuse Rehabilitation Facility
  • Vancouver, WA
  • NPI 1689892473
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574035200000",
    "number": "1053821736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11719 NE 95TH ST STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986822444",
            "telephone_number": "503-490-2292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11719 NE 95TH ST STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986822444",
            "telephone_number": "503-490-2292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2411 Mlk Jr Blvd",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974015824",
            "country_code": "US",
            "telephone_number": "541-682-3608 x7565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOD",
        "first_name": "KAILEY",
        "middle_name": "A",
        "credential": "PSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-06",
        "last_updated": "2019-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OR",
            "license": "PHW2019",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW2019",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WA",
            "license": "CG61009839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "other",
            "affiliation": "N",
            "address_1": "11719 NE 95th St Ste A",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986822444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Jeanne Wong
• Wendy Wong, RPH
• Gabriel Wood-Bianchi, LMT
• Jennifer Robin Wood, LPTA, CIMT
• Julie Eileen Wood, M.S., CCC-SLP
• Karlie Wood
• Laura Nicole Wood, MA, LMHC, CDP
• Marilyn M Wood, M.D.
• Simone Wood
• Stacy Lee Wood

• Peer Specialist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Peer Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.