Individual provider · Type 1 NPI

Jody Marie Ideran

Mental Health Counselor · Bloomington, IL

NPI number 1174619043 Active

Practice location

108 W Market St
Bloomington, IL 61701-3918

Call (309) 827-5351 Map

Fax (309) 829-6808

Mailing address

11 Palm Ct
Bloomington, IL 61701-7849

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1174619043

Jody Marie Ideran's National Provider Identifier is 1174619043, issued on Oct 5, 2006. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Bloomington, IL. The record was last updated on Jul 8, 2007.