Provider Demographics
NPI:1225717432
Name:SOURA, JODY
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:
Last Name:SOURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:HAIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6228 OLD SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040
Mailing Address - Country:US
Mailing Address - Phone:509-570-8525
Mailing Address - Fax:
Practice Address - Street 1:6228 OLD SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-570-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)