Provider Demographics
NPI:1184441628
Name:TRIMBY, JODIE ANNE (LSW)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:ANNE
Last Name:TRIMBY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 DEERPATH PARK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5607
Mailing Address - Country:US
Mailing Address - Phone:217-972-6220
Mailing Address - Fax:
Practice Address - Street 1:1220 UNDERWOOD CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1983
Practice Address - Country:US
Practice Address - Phone:217-972-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150114351104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker