Provider Demographics
NPI:1508204629
Name:ENDICOTT, JODEE LYNN
Entity Type:Individual
Prefix:
First Name:JODEE
Middle Name:LYNN
Last Name:ENDICOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1456
Mailing Address - Country:US
Mailing Address - Phone:541-523-8320
Mailing Address - Fax:541-523-8325
Practice Address - Street 1:3700 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1456
Practice Address - Country:US
Practice Address - Phone:541-523-8320
Practice Address - Fax:541-523-8325
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health