Provider Demographics
NPI:1700126935
Name:WIKTOROWSKI, JODI L (DVM)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:WIKTOROWSKI
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 MOSBY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1777
Mailing Address - Country:US
Mailing Address - Phone:541-942-9132
Mailing Address - Fax:541-942-9134
Practice Address - Street 1:2555 MOSBY CREEK RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1777
Practice Address - Country:US
Practice Address - Phone:541-942-9132
Practice Address - Fax:541-942-9134
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5823174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian