Provider Demographics
NPI:1871834853
Name:WHITNEY, JODY A (MS ED)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:A
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GREENVALE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4238
Mailing Address - Country:US
Mailing Address - Phone:585-217-7563
Mailing Address - Fax:
Practice Address - Street 1:941 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2746
Practice Address - Country:US
Practice Address - Phone:585-473-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY709044131OtherNYS TEACHER CERTIFICATION: STUDENTS WITH DISABILITIES
NY709045131OtherNYS TEACHER CERTIFICATION: EARLY CHILDHOOD EDUCATION