Provider Demographics
NPI:1154576429
Name:WILSON, JODI G (JODI WILSON)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:G
Last Name:WILSON
Suffix:
Gender:F
Credentials:JODI WILSON
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:GIVNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SP-LANG
Mailing Address - Street 1:5 COURT OF HIDDEN WLS
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3209
Mailing Address - Country:US
Mailing Address - Phone:847-715-9898
Mailing Address - Fax:224-723-5151
Practice Address - Street 1:5 COURT OF HIDDEN WLS
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3209
Practice Address - Country:US
Practice Address - Phone:847-715-9898
Practice Address - Fax:224-723-5151
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist