Provider Demographics
NPI:1114562519
Name:CODY, MEGAN (RBT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NE 136TH AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6951
Mailing Address - Country:US
Mailing Address - Phone:360-952-7060
Mailing Address - Fax:
Practice Address - Street 1:120 NE 136TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6951
Practice Address - Country:US
Practice Address - Phone:360-952-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2020-10-14
Deactivation Date:2020-09-17
Deactivation Code:
Reactivation Date:2020-10-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health