Healthcare Provider Details

I. General information

NPI: 1447249438
Provider Name (Legal Business Name): JODY ANN PASSAFUME M.ED,
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 SOUTHPOINT CIR SUITE B
VALPARAISO IN
46385-6265
US

IV. Provider business mailing address

3695 W PAWNEE DR
LAPORTE IN
46350-7953
US

V. Phone/Fax

Practice location:
  • Phone: 219-465-6518
  • Fax: 219-477-6994
Mailing address:
  • Phone: 219-362-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39000488A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002792A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: