Provider Demographics
NPI:1205078540
Name:EDE, JODI L
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:EDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S OREGON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3475
Mailing Address - Country:US
Mailing Address - Phone:530-841-1783
Mailing Address - Fax:530-841-0769
Practice Address - Street 1:1515 S. OREGON STREET
Practice Address - Street 2:SUITE B
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3475
Practice Address - Country:US
Practice Address - Phone:530-841-1783
Practice Address - Fax:530-841-0769
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker