Provider Demographics
NPI:1891295457
Name:WHITE, JODEL (SLP-ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:JODEL
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E HARRISON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9167
Mailing Address - Country:US
Mailing Address - Phone:956-365-3330
Mailing Address - Fax:
Practice Address - Street 1:701 E HARRISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9167
Practice Address - Country:US
Practice Address - Phone:956-365-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360882355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty