Provider Demographics
NPI:1134166796
Name:BITTINGER, JODIE (THERAPIST)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:BITTINGER
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4635
Mailing Address - Country:US
Mailing Address - Phone:406-586-3584
Mailing Address - Fax:
Practice Address - Street 1:4601 NE 77TH AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6729
Practice Address - Country:US
Practice Address - Phone:360-514-9271
Practice Address - Fax:360-397-0777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist