Provider Demographics
NPI:1649572132
Name:SOUTHARD, JODI (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:SOUTHARD
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:PO BOX 1759
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0017
Mailing Address - Country:US
Mailing Address - Phone:940-343-5143
Mailing Address - Fax:
Practice Address - Street 1:601 ELM ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-9635
Practice Address - Country:US
Practice Address - Phone:940-343-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist