Provider Demographics
NPI:1699922450
Name:MAYNARD, JODI L (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:JOLEEN
Other - Middle Name:L
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1401 E 303RD ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1386
Mailing Address - Country:US
Mailing Address - Phone:913-294-8040
Mailing Address - Fax:913-294-8041
Practice Address - Street 1:1401 E 303RD ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1386
Practice Address - Country:US
Practice Address - Phone:913-294-8040
Practice Address - Fax:913-294-8041
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist