Provider Demographics
NPI:1194805317
Name:ANTONINI, JODI ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANN
Last Name:ANTONINI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 NW 49TH PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1734
Mailing Address - Country:US
Mailing Address - Phone:954-818-5433
Mailing Address - Fax:
Practice Address - Street 1:6738 W SUNRISE BLVD
Practice Address - Street 2:SUTIE 107
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6070
Practice Address - Country:US
Practice Address - Phone:954-587-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887567700Medicaid