Provider Demographics
NPI:1710282645
Name:FIELD, JODIE DAWN (MS)
Entity Type:Individual
Prefix:MS
First Name:JODIE
Middle Name:DAWN
Last Name:FIELD
Suffix:
Gender:F
Credentials:MS
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 3163
Mailing Address - Street 2:17 N. ASH
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-3163
Mailing Address - Country:US
Mailing Address - Phone:509-826-5731
Mailing Address - Fax:509-826-1278
Practice Address - Street 1:17 N. ASH
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-826-5731
Practice Address - Fax:509-826-1278
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAF 60059958101YP2500X
WALH60240314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional