Provider Demographics
NPI:1326219049
Name:EILERMAN, JODIE LYNN (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:EILERMAN
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1725
Mailing Address - Country:US
Mailing Address - Phone:937-371-4652
Mailing Address - Fax:
Practice Address - Street 1:1621 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1725
Practice Address - Country:US
Practice Address - Phone:937-371-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist