Provider Demographics
NPI:1447581806
Name:CHESSER, JODY EDWARDS (AUD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:EDWARDS
Last Name:CHESSER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 RACETRACK RD NW STE 20
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1581
Mailing Address - Country:US
Mailing Address - Phone:850-863-4327
Mailing Address - Fax:850-243-8741
Practice Address - Street 1:339 RACETRACK RD NW STE 20
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1581
Practice Address - Country:US
Practice Address - Phone:850-863-4327
Practice Address - Fax:850-243-8741
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1408231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001802501Medicaid