Provider Demographics
NPI:1386839645
Name:JODIE K. SCHULLER & ASSOCIATES
Entity Type:Organization
Organization Name:JODIE K. SCHULLER & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL FACIAL MYOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC, OM
Authorized Official - Phone:858-509-1131
Mailing Address - Street 1:2002 JIMMY DURANTE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2258
Mailing Address - Country:US
Mailing Address - Phone:858-509-1131
Mailing Address - Fax:858-509-1151
Practice Address - Street 1:2002 JIMMY DURANTE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2258
Practice Address - Country:US
Practice Address - Phone:858-509-1131
Practice Address - Fax:858-509-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 6437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty