Provider Demographics
NPI:1790084770
Name:FOLMNSBEE, JODI LYNNE
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNNE
Last Name:FOLMNSBEE
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 1:1743 N OAKCREST AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3492
Mailing Address - Country:US
Mailing Address - Phone:217-433-6888
Mailing Address - Fax:
Practice Address - Street 1:500 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3336
Practice Address - Country:US
Practice Address - Phone:217-475-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILDO NOT HAVE YET222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist