Provider Demographics
NPI:1336243435
Name:RICE, JODY ELAINE (MS-CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:ELAINE
Last Name:RICE
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:115 JA RAMSEY LN
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6270
Mailing Address - Country:US
Mailing Address - Phone:423-426-2668
Mailing Address - Fax:423-979-3404
Practice Address - Street 1:SPEECH CLINIC (126)
Practice Address - Street 2:JAMES H. QUILLEN VAMC
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3404
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3006OtherSTATE LISCENSE