Healthcare Provider Details

I. General information

NPI: 1174368815
Provider Name (Legal Business Name): JODIA R FEDCHOCK CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 BIRMINGHAM DR
FORT COLLINS CO
80526-2312
US

IV. Provider business mailing address

3152 BIRMINGHAM DR
FORT COLLINS CO
80526-2312
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-0138
  • Fax:
Mailing address:
  • Phone: 970-829-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM24060498
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: