Basic Information
Provider Information | |||||||||
NPI: | 1881079630 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CODDING | ||||||||
FirstName: | ELISHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW, CADCI | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1234 | ||||||||
Address2: |   | ||||||||
City: | SAINT HELENS | ||||||||
State: | OR | ||||||||
PostalCode: | 970518234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5033975211 | ||||||||
FaxNumber: | 5033975373 | ||||||||
Practice Location | |||||||||
Address1: | 51577 COLUMBIA RIVER HWY STE C | ||||||||
Address2: |   | ||||||||
City: | SCAPPOOSE | ||||||||
State: | OR | ||||||||
PostalCode: | 970568409 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5033964807 | ||||||||
FaxNumber: | 5035432616 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2015 | ||||||||
LastUpdateDate: | 09/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X |   |   | N |   | Behavioral Health & Social Service Providers | Counselor |   | 101YA0400X | 16-10-02 | OR | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | L7762 | OR | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.