Provider Demographics
NPI:1013272905
Name:MITCHELL, JODI MARIE
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:M
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:8069 CANNONSBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9006
Mailing Address - Country:US
Mailing Address - Phone:616-874-5304
Mailing Address - Fax:
Practice Address - Street 1:8069 CANNONSBURG RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9006
Practice Address - Country:US
Practice Address - Phone:616-874-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist