Provider Demographics
NPI:1265718597
Name:VONSANDEN, JODY LYNNE
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNNE
Last Name:VONSANDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYNNE
Other - Last Name:PADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7063 COURT RD
Mailing Address - Street 2:
Mailing Address - City:PAVILION
Mailing Address - State:NY
Mailing Address - Zip Code:14525-9306
Mailing Address - Country:US
Mailing Address - Phone:585-584-8537
Mailing Address - Fax:585-584-8537
Practice Address - Street 1:7063 COURT RD
Practice Address - Street 2:
Practice Address - City:PAVILION
Practice Address - State:NY
Practice Address - Zip Code:14525-9306
Practice Address - Country:US
Practice Address - Phone:585-584-8537
Practice Address - Fax:585-584-8537
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist