Provider Demographics
NPI:1447314117
Name:JEDLICKA, JODY ANN (AUD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:ANN
Last Name:JEDLICKA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4164
Mailing Address - Country:US
Mailing Address - Phone:920-233-1800
Mailing Address - Fax:920-232-1538
Practice Address - Street 1:1820 W POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4164
Practice Address - Country:US
Practice Address - Phone:920-233-1800
Practice Address - Fax:920-232-1538
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164-156237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41122200Medicaid