Provider Demographics
NPI:1346800281
Name:STRATTON, JODY M (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:M
Last Name:STRATTON
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 1:151 KALMUS DR STE A101
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5900
Mailing Address - Country:US
Mailing Address - Phone:714-957-4074
Mailing Address - Fax:
Practice Address - Street 1:151 KALMUS DR STE A101
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5900
Practice Address - Country:US
Practice Address - Phone:714-957-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952646580OtherGROUP PROVIDER NPI