Individual
JODI MAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
265 STEAMBOAT LN, BALLWIN, MO 63011-3203
(636) 227-2330
Mailing address
265 STEAMBOAT LN, BALLWIN, MO 63011-3203
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2016022766
MO
Other
Enumeration date
02/21/2017
Last updated
02/21/2017
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