Provider Demographics
NPI:1528180353
Name:HERRMANN, JODI C (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:C
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 COCKLE LN
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6881
Mailing Address - Country:US
Mailing Address - Phone:843-522-9679
Mailing Address - Fax:
Practice Address - Street 1:306 COCKLE LN
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-6881
Practice Address - Country:US
Practice Address - Phone:843-522-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist