Provider Demographics
NPI:1508925280
Name:HORNER, JODY L
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:L
Last Name:HORNER
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 1:14067 HIGHWAY E
Mailing Address - Street 2:
Mailing Address - City:CURRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63339-2030
Mailing Address - Country:US
Mailing Address - Phone:573-470-5550
Mailing Address - Fax:
Practice Address - Street 1:2122 AUDRAIN ROAD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:MO
Practice Address - Zip Code:63882
Practice Address - Country:US
Practice Address - Phone:573-594-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist