Healthcare Provider Details

I. General information

NPI: 1215501614
Provider Name (Legal Business Name): JODIE N MANTHEI SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 FIDAY RD
JOLIET IL
60431-0644
US

IV. Provider business mailing address

3209 FIDAY RD
JOLIET IL
60431-0644
US

V. Phone/Fax

Practice location:
  • Phone: 815-733-8643
  • Fax:
Mailing address:
  • Phone: 815-733-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.014969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: