Provider Demographics
NPI:1841954716
Name:DETOFFOL, JODI (SLP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:DETOFFOL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:STEGMEIR
Other - Last Name:DETOFFOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:9633 YUKON AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1650
Mailing Address - Country:US
Mailing Address - Phone:612-424-9890
Mailing Address - Fax:
Practice Address - Street 1:9633 YUKON AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1650
Practice Address - Country:US
Practice Address - Phone:612-424-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist