Basic Information
| Provider Information | |||||||||
| NPI: | 1144729914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CODY | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 HILLCREST DR | ||||||||
| Address2: | |||||||||
| City: | BARDWELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420238574 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4747 ALBEN BARKLEY DR | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420016789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704449661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2018 | ||||||||
| LastUpdateDate: | 02/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 173513 | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.