Provider Demographics
NPI:1457833287
Name:GERVAIS, JODIE (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 CLAIBORNE CT
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7056
Mailing Address - Country:US
Mailing Address - Phone:614-738-8886
Mailing Address - Fax:
Practice Address - Street 1:1418 CLAIBORNE CT
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-7056
Practice Address - Country:US
Practice Address - Phone:614-738-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01255237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter