Provider Demographics
NPI:1346889664
Name:DR THERESA CODDINGTON PA
Entity Type:Organization
Organization Name:DR THERESA CODDINGTON PA
Other - Org Name:THERESA CODDINGTON, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CODDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-291-4666
Mailing Address - Street 1:11011 KING ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1203
Mailing Address - Country:US
Mailing Address - Phone:913-291-4666
Mailing Address - Fax:
Practice Address - Street 1:11011 KING ST STE 105
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1203
Practice Address - Country:US
Practice Address - Phone:913-291-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100384950Medicaid