Provider Demographics
NPI:1134377567
Name:CODAMO, JANE M (SLP)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:CODAMO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:CODAMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:5545 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4205
Mailing Address - Country:US
Mailing Address - Phone:520-296-2306
Mailing Address - Fax:520-296-4072
Practice Address - Street 1:5545 E LEE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4205
Practice Address - Country:US
Practice Address - Phone:520-296-2306
Practice Address - Fax:520-296-4072
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP0351Medicare UPIN