Provider Demographics
NPI:1710523949
Name:CHLOUBER, JODIE LYNN
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:CHLOUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 ELY ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-1661
Mailing Address - Country:US
Mailing Address - Phone:559-679-3531
Mailing Address - Fax:
Practice Address - Street 1:1130 ELY ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-1661
Practice Address - Country:US
Practice Address - Phone:559-679-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician