Provider Demographics
NPI:1881930246
Name:EAST, JODI RAE (MS, PLPC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:RAE
Last Name:EAST
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S PEARL AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-4334
Mailing Address - Country:US
Mailing Address - Phone:417-781-4552
Mailing Address - Fax:417-777-1707
Practice Address - Street 1:12089 LAWRENCE 2220
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:MO
Practice Address - Zip Code:65769-8186
Practice Address - Country:US
Practice Address - Phone:417-379-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional