MEDICARE: JODI STAUFFER THERAPY PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316690704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JODI STAUFFER THERAPY PLLC

Provider Business Mailing Address
First Line	:	102 WONDER WORLD DR STE 304-147
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-6076
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 WONDER WORLD DR STE 304-147
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-6076
Country	:	US
Telephone Number	:	830-431-6161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JODIE STAUFFER
Credential	:
Telephone Number	:	830-431-6161

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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