Basic Information
| Provider Information | |||||||||
| NPI: | 1619461415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHENEY | ||||||||
| FirstName: | CODY | ||||||||
| MiddleName: | AMMON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 W UNIVERSITY PKWY | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840586703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018638876 | ||||||||
| FaxNumber: | 8018637056 | ||||||||
| Practice Location | |||||||||
| Address1: | 10011 SE DIVISION ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552343 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2018 | ||||||||
| LastUpdateDate: | 06/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.