Provider Demographics
NPI:1609659481
Name:BODILY, KATHI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:BODILY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 N DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-9016
Mailing Address - Country:US
Mailing Address - Phone:435-979-1868
Mailing Address - Fax:
Practice Address - Street 1:451 E 400 N
Practice Address - Street 2:WEST INSTRUCTION BLD, RM 120
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-613-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096031235Z00000X
ID4904235Z00000X
UT9828347-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist