Provider Demographics
NPI:1598337834
Name:DAUM, JODI K (LLPC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:K
Last Name:DAUM
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 STEVENS LN
Mailing Address - Street 2:
Mailing Address - City:MECOSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49332-9504
Mailing Address - Country:US
Mailing Address - Phone:231-250-2347
Mailing Address - Fax:
Practice Address - Street 1:1205 S MISSION ST STE 14
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3939
Practice Address - Country:US
Practice Address - Phone:231-250-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor