Provider Demographics
NPI:1295431161
Name:KRAFT, JODIE MARIE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:MARIE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E SHADYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3038
Mailing Address - Country:US
Mailing Address - Phone:937-245-0602
Mailing Address - Fax:
Practice Address - Street 1:37 E SHADYSIDE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3038
Practice Address - Country:US
Practice Address - Phone:937-245-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist