MEDICARE: JODI SUE DAVIS-LABADIE CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SP-1005	NV

General Provider Information

NPI Number	:	1710252853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI SUE DAVIS-LABADIE CCC-SLP

Provider Business Mailing Address
First Line	:	8325 MONICO VALLEY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2005
Country	:	US
Telephone Number	:	702-286-2398
Fax Number	:

Provider Business Practice Location Address
First Line	:	5552 S FORT APACHE RD
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7694
Country	:	US
Telephone Number	:	702-641-8255
Fax Number	:

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

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	03/21/2012

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