Provider Demographics
NPI:1366063828
Name:ZACHARY, JODI MAY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MAY
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 JASMINE AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3454
Mailing Address - Country:US
Mailing Address - Phone:612-767-6272
Mailing Address - Fax:
Practice Address - Street 1:8320 JASMINE AVE S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3454
Practice Address - Country:US
Practice Address - Phone:651-226-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN129312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry