MEDICARE: JODY NEESON MA

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1154713691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY NEESON MA

Provider Business Mailing Address
First Line	:	812 GARFIELD DR
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-4634
Country	:	US
Telephone Number	:	707-481-8119
Fax Number	:	415-276-4536

Provider Business Practice Location Address
First Line	:	812 GARFIELD DR
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-4634
Country	:	US
Telephone Number	:	707-481-8119
Fax Number	:	415-276-4536

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

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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