Provider Demographics
NPI:1366572919
Name:JODAH, MARCIA THERESA (MS, LCGC)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:THERESA
Last Name:JODAH
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 W SAN NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6046
Mailing Address - Country:US
Mailing Address - Phone:800-242-2787
Mailing Address - Fax:
Practice Address - Street 1:500 S CHIPETA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1221
Practice Address - Country:US
Practice Address - Phone:800-242-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96117170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS