Provider Demographics
NPI:1609182336
Name:CORNELIUS, JODIE L (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JODIE
Middle Name:L
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-1631
Mailing Address - Country:US
Mailing Address - Phone:817-999-4954
Mailing Address - Fax:
Practice Address - Street 1:2800 WARWICK DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-1631
Practice Address - Country:US
Practice Address - Phone:817-999-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist