MEDICARE: JONA RAY DODD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083442347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONA RAY DODD

Provider Business Mailing Address
First Line	:	644 RAY LN
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2466
Country	:	US
Telephone Number	:	541-404-4483
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 S. MAIN STREET
Second Line	:	PO BOX 1257
City	:	PHOENIX
State	:	OR
Zip	:	97535-1257
Country	:	US
Telephone Number	:	541-535-4133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “ JONA RAY DODD ” Practice Location

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