Provider Demographics
NPI:1356667349
Name:ABBOTT, JODEANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JODEANNE
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 FORESTWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715
Mailing Address - Country:US
Mailing Address - Phone:352-536-2561
Mailing Address - Fax:407-264-6557
Practice Address - Street 1:1054 TELFAIR LINE RD.
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:GA
Practice Address - Zip Code:31060
Practice Address - Country:US
Practice Address - Phone:229-362-4088
Practice Address - Fax:229-868-7495
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist