Provider Demographics
NPI:1023248465
Name:KNODELL, JODIE LEE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:JODIE
Middle Name:LEE
Last Name:KNODELL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10547 MONTGOMERY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4418
Mailing Address - Country:US
Mailing Address - Phone:888-830-0347
Mailing Address - Fax:
Practice Address - Street 1:1125 ELLEN KAY DR STE D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6358
Practice Address - Country:US
Practice Address - Phone:844-533-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN320561163WC0400X, 163WH0200X
OHAPRN.CNP.0032558363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health