Provider Demographics
NPI:1306196977
Name:MONROE, JODI K (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:K
Last Name:MONROE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:K
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1900 DANIELS ST
Mailing Address - Street 2:HOUGH SCHOOL
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2535
Mailing Address - Country:US
Mailing Address - Phone:360-313-2100
Mailing Address - Fax:360-313-2101
Practice Address - Street 1:1900 DANIELS ST
Practice Address - Street 2:HOUGH SCHOOL
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2535
Practice Address - Country:US
Practice Address - Phone:360-313-2100
Practice Address - Fax:360-313-2101
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist