Provider Demographics
NPI:1124112297
Name:COTTRELL, JODI C (AUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:C
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 13TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1692
Mailing Address - Country:US
Mailing Address - Phone:304-522-8800
Mailing Address - Fax:304-523-4303
Practice Address - Street 1:1 JOHN MARSHALL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-1692
Practice Address - Country:US
Practice Address - Phone:304-696-3455
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0392237600000X
WVA0158237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY70000393Medicaid
WV7402120000Medicaid