Provider Demographics
NPI:1841870011
Name:CODY, JESSICA MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CODY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 JOCELYN AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1401
Mailing Address - Country:US
Mailing Address - Phone:201-321-8902
Mailing Address - Fax:
Practice Address - Street 1:265 ACKERMAN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4200
Practice Address - Country:US
Practice Address - Phone:201-297-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01069000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty