Provider Demographics
NPI:1740309731
Name:MCWHORTER, JODY L
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:MCWHORTER
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 1:616 BOWEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNA
Mailing Address - State:IL
Mailing Address - Zip Code:61074-2202
Mailing Address - Country:US
Mailing Address - Phone:815-273-4909
Mailing Address - Fax:
Practice Address - Street 1:1126 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1469
Practice Address - Country:US
Practice Address - Phone:815-244-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health