Provider Demographics
NPI:1194970996
Name:OETKEN, JODY LYNN (MA/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:OETKEN
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 MORIARTY DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-5526
Mailing Address - Country:US
Mailing Address - Phone:605-696-0282
Mailing Address - Fax:
Practice Address - Street 1:2110 MORIARTY DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-5526
Practice Address - Country:US
Practice Address - Phone:605-696-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist