Provider Demographics
NPI:1215501614
Name:MANTHEI, JODIE N (SLP)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:N
Last Name:MANTHEI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 CENTER COURT
Mailing Address - Street 2:UNIT D
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-730-4800
Mailing Address - Fax:815-730-1835
Practice Address - Street 1:803 CENTER COURT
Practice Address - Street 2:UNIT D
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404
Practice Address - Country:US
Practice Address - Phone:815-730-1800
Practice Address - Fax:815-730-1835
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty