Provider Demographics
NPI:1366797656
Name:KERSHNER, JODY LOUISE (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LOUISE
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2288 FOREST GREEN CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2503
Mailing Address - Country:US
Mailing Address - Phone:404-308-7057
Mailing Address - Fax:770-977-7057
Practice Address - Street 1:2288 FOREST GREEN CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2503
Practice Address - Country:US
Practice Address - Phone:404-308-7057
Practice Address - Fax:770-977-7057
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist