Doctor Name: | HEATHER MICHELLE CODY |
NPI Number: | 1316227440 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 178005759 |
Business Practice Address: | 525 E North St Suite B Bradley, IL - 609151185 |
Business Phone Number: | 7734479245 |
Business Fax Number: | |
Mailing Address: | 525 E North St, Suite B BRADLEY |
State: | IL |
Postal Code: | 609151185 |
Phone Number: | 7734479245 |
Fax Number: | |
NPI Enumeration Date: | 08/20/2011 |
NPI Last Update Date: | 09/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 178005759 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |