Provider Demographics
NPI:1962096537
Name:ZEADOW, JODY LEE (SLP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:LEE
Last Name:ZEADOW
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LEE
Other - Last Name:HEETLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:233 N HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 N HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5168
Practice Address - Country:US
Practice Address - Phone:641-895-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099499235Z00000X
NE2631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist