Provider Demographics
NPI:1609250646
Name:CODEKAS, ENNA ALEXANDRA (MS-CF)
Entity Type:Individual
Prefix:MRS
First Name:ENNA
Middle Name:ALEXANDRA
Last Name:CODEKAS
Suffix:
Gender:F
Credentials:MS-CF
Other - Prefix:
Other - First Name:ENNA
Other - Middle Name:ALEXANDRA
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17615 85TH AVENUE CT E STE C
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-1902
Mailing Address - Country:US
Mailing Address - Phone:253-216-2589
Mailing Address - Fax:253-754-4016
Practice Address - Street 1:17615 85TH AVENUE CT E STE C
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-1902
Practice Address - Country:US
Practice Address - Phone:253-216-2589
Practice Address - Fax:253-754-4016
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist