Provider Demographics
NPI:1689225831
Name:THOMAS, JODI LYNN (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
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 7684
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7684
Mailing Address - Country:US
Mailing Address - Phone:480-256-9898
Mailing Address - Fax:
Practice Address - Street 1:1050 N LONGMORE ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4075
Practice Address - Country:US
Practice Address - Phone:480-256-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP12724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist