Provider Demographics
NPI:1801680319
Name:HOUSTON, JODY THERESA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:THERESA
Last Name:HOUSTON
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-8382
Mailing Address - Country:US
Mailing Address - Phone:772-539-1038
Mailing Address - Fax:
Practice Address - Street 1:104 PRESTWICK DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-8382
Practice Address - Country:US
Practice Address - Phone:772-539-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA688235Z00000X
GASLP013484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist