Provider Demographics
NPI:1346752128
Name:SOUTH, JODI S (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:SOUTH
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 1:8810 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7708
Mailing Address - Country:US
Mailing Address - Phone:859-801-4934
Mailing Address - Fax:
Practice Address - Street 1:8810 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7708
Practice Address - Country:US
Practice Address - Phone:859-801-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGN126Medicaid