Provider Demographics
NPI:1396021796
Name:BARNHART, JODI (BSRSST)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:
Last Name:BARNHART
Suffix:
Gender:F
Credentials:BSRSST
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:SHUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24066 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4066
Mailing Address - Country:US
Mailing Address - Phone:734-324-8326
Mailing Address - Fax:734-324-8327
Practice Address - Street 1:14799 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2507
Practice Address - Country:US
Practice Address - Phone:734-324-8326
Practice Address - Fax:723-324-8327
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker