Provider Demographics
NPI:1700012259
Name:SKEEN, JODI (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:SKEEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 BURNEY RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1336
Mailing Address - Country:US
Mailing Address - Phone:336-953-9368
Mailing Address - Fax:336-381-0211
Practice Address - Street 1:1849 BURNEY RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-1336
Practice Address - Country:US
Practice Address - Phone:336-953-9368
Practice Address - Fax:336-381-0211
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413255Medicaid