Individual
JODI LYNN DEZALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
3915 GOLDEN VALLEY ROAD, COURAGE CENTER, GOLDEN VALLEY, MN 55422-4298
(763) 520-0714
(763) 520-0355
Mailing address
3915 GOLDEN VALLEY ROAD, COURAGE CENTER, GOLDEN VALLEY, MN 55422-4298
(763) 520-0714
(763) 520-0355
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7929
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083HIDE
BCBS MINNESOTA
MN
01
—
4600930
MEDICA
MN
01
—
HP56680
HEALTHPARTNERS
MN
Enumeration date
03/14/2007
Last updated
07/08/2007
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