Provider Demographics
NPI:1588724363
Name:MARTIN, JODI A (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 6TH ST E
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1654
Mailing Address - Country:US
Mailing Address - Phone:651-292-9237
Mailing Address - Fax:
Practice Address - Street 1:287 6TH ST E
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1654
Practice Address - Country:US
Practice Address - Phone:651-292-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN95462OtherHEALTHPARTNERS INURANCE
MN6162895OtherUNITED HEALTHCARE
MN173L2MAOtherBLUE CROSS INDIVIDUAL