Provider Demographics
NPI:1518256965
Name:GABBARD, JODI L
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:GABBARD
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 1:2635 MILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-9096
Mailing Address - Country:US
Mailing Address - Phone:810-338-7556
Mailing Address - Fax:
Practice Address - Street 1:2635 MILLVILLE RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-9096
Practice Address - Country:US
Practice Address - Phone:810-338-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist