Provider Demographics
NPI:1215314661
Name:VAILES, JODI AMMONS
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:AMMONS
Last Name:VAILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 YORK RD
Mailing Address - Street 2:TOWSON UNIVERSITY INSTITUTE FOR WELL-BEING
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21252-0001
Mailing Address - Country:US
Mailing Address - Phone:410-704-7300
Mailing Address - Fax:410-704-6303
Practice Address - Street 1:1 OLYMPIC PL
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4104
Practice Address - Country:US
Practice Address - Phone:410-704-7300
Practice Address - Fax:410-704-6303
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist