Provider Demographics
NPI:1750331898
Name:O'TOOLE, JODIE M (SLP)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:M
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3238 62ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2731
Mailing Address - Country:US
Mailing Address - Phone:206-753-7668
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:H4PMR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-341-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA84784UOtherREGENCE BLUE SHIELD PIN
WA1026OTOtherREGENCE BLUE SHIELD PIN