Provider Demographics
NPI:1275867723
Name:MILJAVAC, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:MILJAVAC
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 1:10264 US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MO
Mailing Address - Zip Code:64443-4228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10264 US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MO
Practice Address - Zip Code:64443-4228
Practice Address - Country:US
Practice Address - Phone:816-752-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005039226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist