Provider Demographics
NPI:1861687139
Name:WHITE, JODIE LYNN (MT-BC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 SISK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-2021
Mailing Address - Country:US
Mailing Address - Phone:940-687-0962
Mailing Address - Fax:
Practice Address - Street 1:4529 SISK RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-2021
Practice Address - Country:US
Practice Address - Phone:940-687-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist