Provider Demographics
NPI:1093497695
Name:DODGE, JENNA C (CCH)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:C
Last Name:DODGE
Suffix:
Gender:F
Credentials:CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7135
Mailing Address - Country:US
Mailing Address - Phone:406-581-0459
Mailing Address - Fax:
Practice Address - Street 1:205 HAGGERTY LN STE 290
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8800
Practice Address - Country:US
Practice Address - Phone:406-581-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath