Jessica Brodie, M.S., CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Driggs, ID
NPI 1740588276 · NPPES record last updated Mar 8, 2011
Key facts
- NPI
- 1740588276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP-2012 (ID)
- Practice address
- 165 Front Street
Driggs, ID 83442 - Phone
- (307) 349-5377
- NPI assigned
- Mar 8, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-2012 | ID | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-2012 | ID | Yes |
Addresses
Primary practice location
165 Front Street
Driggs, ID 83442
Mailing address
165 Front Street
Driggs, ID 83442
Phone (307) 349-5377
Other providers in Driggs, ID
- Michelle Bodenhamer
- Liesje Chantal Bouwman
- Halina Boyd
- Brent Blue MD
- Jennifer Lynn Brinson
- Broulim Supermarkets, LLC
- Melanie Brower
- Jacqueline Lee Brown
- Theodore Paul Bryson
- Erica J Burns
All providers in Driggs, ID · Speech-Language Pathologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.