Provider Demographics
NPI:1497195325
Name:MING, JODI MICHELLE (BA)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MICHELLE
Last Name:MING
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:MICHELLE
Other - Last Name:STOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6505 218TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2135
Mailing Address - Country:US
Mailing Address - Phone:206-365-0809
Mailing Address - Fax:206-365-0872
Practice Address - Street 1:901 N MONROE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2104
Practice Address - Country:US
Practice Address - Phone:509-328-2740
Practice Address - Fax:509-328-0773
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60384970103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst