Provider Demographics
NPI:1619440815
Name:SHAW HODGE, JODIE-ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JODIE-ANN
Middle Name:
Last Name:SHAW HODGE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8809 SUMNER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3533
Mailing Address - Country:US
Mailing Address - Phone:301-523-5684
Mailing Address - Fax:
Practice Address - Street 1:12711 MILAN WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1611
Practice Address - Country:US
Practice Address - Phone:301-805-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist