Provider Demographics
NPI:1679591671
Name:LARIMORE, JODY WEISSENBORN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:WEISSENBORN
Last Name:LARIMORE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MISS
Other - First Name:JODY
Other - Middle Name:KELLY
Other - Last Name:WEISSENBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 N GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5748
Mailing Address - Country:US
Mailing Address - Phone:586-758-5051
Mailing Address - Fax:
Practice Address - Street 1:309 N GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5748
Practice Address - Country:US
Practice Address - Phone:586-758-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000081231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679591671Medicaid
MIN71920007Medicare PIN