Provider Demographics
NPI:1225608839
Name:BODISH, EMILY ANNE (DR)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:BODISH
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W RANDOL MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5810
Mailing Address - Country:US
Mailing Address - Phone:817-277-7039
Mailing Address - Fax:
Practice Address - Street 1:101 W RANDOL MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5810
Practice Address - Country:US
Practice Address - Phone:817-277-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81290231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist