Provider Demographics
NPI:1043254204
Name:HASTINGS, JODIE (THERAPIST)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 220TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6835
Mailing Address - Country:US
Mailing Address - Phone:425-898-8415
Mailing Address - Fax:
Practice Address - Street 1:1129 W MAIN ST STE 194
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2034
Practice Address - Country:US
Practice Address - Phone:206-697-3577
Practice Address - Fax:360-805-9491
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist