Provider Demographics
NPI:1336501386
Name:STEFFES, JODI L (LMT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:STEFFES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 W JEFFERSON AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2902
Mailing Address - Country:US
Mailing Address - Phone:734-624-3535
Mailing Address - Fax:
Practice Address - Street 1:2836 W JEFFERSON AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2902
Practice Address - Country:US
Practice Address - Phone:734-624-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501005244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist