Provider Demographics
NPI:1417103888
Name:LODGE, JODI LEE (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEE
Last Name:LODGE
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 1:142 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2198
Mailing Address - Country:US
Mailing Address - Phone:740-772-8107
Mailing Address - Fax:
Practice Address - Street 1:142 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2198
Practice Address - Country:US
Practice Address - Phone:740-772-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist