Provider Demographics
NPI:1215214002
Name:MECHAM, JODY MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:JODY
Middle Name:MICHELLE
Last Name:MECHAM
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 1:862 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3320
Mailing Address - Country:US
Mailing Address - Phone:435-723-9442
Mailing Address - Fax:
Practice Address - Street 1:862 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3320
Practice Address - Country:US
Practice Address - Phone:435-723-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency