Doctor Name: | MRS. JODI SOUTHARD |
NPI Number: | 1649572132 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.,CCC-SLP |
License Number: | 102916 |
Business Practice Address: | 1300 Memorial Dr Denison, TX - 75020 |
Business Phone Number: | 9034826455 |
Business Fax Number: | |
Mailing Address: | 2704 Fritz St, MELISSA |
State: | TX |
Postal Code: | 754542484 |
Phone Number: | 9038158880 |
Fax Number: | |
NPI Enumeration Date: | 12/03/2010 |
NPI Last Update Date: | 12/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 102916 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |