Provider Demographics
NPI:1861232472
Name:COPELAND, JODI (BSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 E IRON EAGLE DR STE 166
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6557
Mailing Address - Country:US
Mailing Address - Phone:986-217-4584
Mailing Address - Fax:208-718-2385
Practice Address - Street 1:1036 E IRON EAGLE DR STE 166
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6557
Practice Address - Country:US
Practice Address - Phone:986-217-4584
Practice Address - Fax:208-718-2385
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator