Provider Demographics
NPI:1730801978
Name:SIMMONS, JODI (BA, MHP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1549
Mailing Address - Country:US
Mailing Address - Phone:618-658-3079
Mailing Address - Fax:618-657-2759
Practice Address - Street 1:204 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1549
Practice Address - Country:US
Practice Address - Phone:618-658-3079
Practice Address - Fax:618-657-2759
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health