Provider Demographics
NPI:1003469438
Name:BODINE, KARLEE MICHELE
Entity Type:Individual
Prefix:
First Name:KARLEE
Middle Name:MICHELE
Last Name:BODINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLEE
Other - Middle Name:MICHELE
Other - Last Name:MAWHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12851 MAGNOLIA CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-5503
Mailing Address - Country:US
Mailing Address - Phone:260-213-0286
Mailing Address - Fax:
Practice Address - Street 1:902 PROVIDENT DR STE C
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3379
Practice Address - Country:US
Practice Address - Phone:574-376-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007223A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist