Provider Demographics
NPI:1144379009
Name:MAGNUSSON, JODINE L
Entity Type:Individual
Prefix:MRS
First Name:JODINE
Middle Name:L
Last Name:MAGNUSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 NEWAUKUM VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8873
Mailing Address - Country:US
Mailing Address - Phone:360-748-2141
Mailing Address - Fax:
Practice Address - Street 1:2958 LIMITED LN NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4577
Practice Address - Country:US
Practice Address - Phone:360-704-7900
Practice Address - Fax:360-704-7909
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA2656237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist