Healthcare Provider Details

I. General information

NPI: 1083643571
Provider Name (Legal Business Name): JODI L ROUTSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI RICHARDSON LCSW, LCAC

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W 13TH ST
JASPER IN
47546-1855
US

IV. Provider business mailing address

800 W 9TH ST
JASPER IN
47546-2514
US

V. Phone/Fax

Practice location:
  • Phone: 812-481-5780
  • Fax:
Mailing address:
  • Phone: 812-996-0419
  • Fax: 812-996-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33004788A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: