Provider Demographics
NPI:1447249438
Name:PASSAFUME, JODY ANN (MED,)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:ANN
Last Name:PASSAFUME
Suffix:
Gender:F
Credentials:MED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 W PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-7953
Mailing Address - Country:US
Mailing Address - Phone:219-362-4854
Mailing Address - Fax:
Practice Address - Street 1:951 SOUTHPOINT CIR
Practice Address - Street 2:SUITE B
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6265
Practice Address - Country:US
Practice Address - Phone:219-465-6518
Practice Address - Fax:219-477-6994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000488A101YP2500X
IN34002792A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical