Provider Demographics
NPI:1225417967
Name:WILKINS, JODI ELYSE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ELYSE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 S MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9373
Mailing Address - Country:US
Mailing Address - Phone:734-971-3220
Mailing Address - Fax:
Practice Address - Street 1:4145 S MICHAEL RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9373
Practice Address - Country:US
Practice Address - Phone:734-971-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist