Provider Demographics
NPI:1821666090
Name:CONANT, JODY VANDENBERG (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:VANDENBERG
Last Name:CONANT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:1840 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2921
Mailing Address - Country:US
Mailing Address - Phone:616-382-0532
Mailing Address - Fax:616-774-7760
Practice Address - Street 1:1840 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2921
Practice Address - Country:US
Practice Address - Phone:616-382-0532
Practice Address - Fax:616-774-7760
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist