Healthcare Provider Details

I. General information

NPI: 1518821826
Provider Name (Legal Business Name): JODIE SHRODE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 BARLETTA LN UNIT 714
ESTERO FL
33928-5600
US

IV. Provider business mailing address

20000 BARLETTA LN UNIT 714
ESTERO FL
33928-5600
US

V. Phone/Fax

Practice location:
  • Phone: 779-771-1112
  • Fax:
Mailing address:
  • Phone: 779-771-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: