Provider Demographics
NPI:1013556786
Name:MENDEZ, JODEE (MAE)
Entity Type:Individual
Prefix:
First Name:JODEE
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1117
Mailing Address - Country:US
Mailing Address - Phone:307-532-4197
Mailing Address - Fax:
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3340
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health