Provider Demographics
NPI:1508849092
Name:PAGE, JODEL (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JODEL
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-1611
Mailing Address - Country:US
Mailing Address - Phone:320-267-3286
Mailing Address - Fax:
Practice Address - Street 1:1507 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-1611
Practice Address - Country:US
Practice Address - Phone:320-267-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN7704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41163580956301B009OtherCHAMPUS
MN4600801OtherMEDICA PROVIDER ID
MNHP46881OtherHEALTHPARTNERS ID
MN497T4CAOtherBCBS PROVIDER ID