Provider Demographics
NPI:1003382656
Name:ALATORRE, JODI MEGUMI (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MEGUMI
Last Name:ALATORRE
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 E SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3342
Mailing Address - Country:US
Mailing Address - Phone:559-432-3303
Mailing Address - Fax:
Practice Address - Street 1:1351 E SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3342
Practice Address - Country:US
Practice Address - Phone:559-432-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist