Provider Demographics
NPI:1336494764
Name:DAVIS, JODI LEIGH (MS)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LEIGH
Other - Last Name:STOUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:632 CAPSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5162
Mailing Address - Country:US
Mailing Address - Phone:434-907-8133
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR PEDIATRIC THERAPIES
Practice Address - Street 2:175 DEER RUN ROAD
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540
Practice Address - Country:US
Practice Address - Phone:434-797-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000165L235Z00000X
VA2202007327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist