Provider Demographics
NPI:1790721124
Name:MENSINK, JODIE LYNN (AUD CCC A)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:LYNN
Last Name:MENSINK
Suffix:
Gender:F
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 WOODWINDS DRIVE
Mailing Address - Street 2:#120
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-702-0750
Mailing Address - Fax:651-645-6166
Practice Address - Street 1:2080 WOODWINDS DRIVE
Practice Address - Street 2:#240
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:651-702-0749
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6289231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist