Provider Demographics
NPI:1508016676
Name:HODOM, JAMIE SUE (CMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUE
Last Name:HODOM
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81626-1350
Mailing Address - Country:US
Mailing Address - Phone:970-620-4678
Mailing Address - Fax:970-620-4678
Practice Address - Street 1:370 SAGE CT
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2242
Practice Address - Country:US
Practice Address - Phone:970-620-4678
Practice Address - Fax:970-620-4678
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist