Provider Demographics
NPI:1407080369
Name:KAPLA MASON, JODI M (LAC MT(ASCP))
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:KAPLA MASON
Suffix:
Gender:F
Credentials:LAC MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CAMINO MIRAMONTES
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-8052
Mailing Address - Country:US
Mailing Address - Phone:575-779-4851
Mailing Address - Fax:
Practice Address - Street 1:2110 EAGLE CREEK LN STE 400
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-3209
Practice Address - Country:US
Practice Address - Phone:575-779-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225500000X
MN1894171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI986-55OtherWISCONSIN ACUPUNCTURE LICENSE
MN1894OtherMINNESOTA ACUPUNCTURE LICENSE
20064OtherNCCAOM