Provider Demographics
NPI:1164186094
Name:BOE, JODI LYN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYN
Last Name:BOE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MRS
Other - First Name:JODI
Other - Middle Name:LYN
Other - Last Name:BOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:0S566 ELLITHORP LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-6170
Mailing Address - Country:US
Mailing Address - Phone:847-212-4042
Mailing Address - Fax:
Practice Address - Street 1:0S566 ELLITHORP LN
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-6170
Practice Address - Country:US
Practice Address - Phone:847-212-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-004153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist