Provider Demographics
NPI:1831676063
Name:DEXTER, CODY SCOTT (MS MFT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:SCOTT
Last Name:DEXTER
Suffix:
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CHIEFTAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020
Mailing Address - Country:US
Mailing Address - Phone:715-417-3241
Mailing Address - Fax:
Practice Address - Street 1:108 CHIEFTAIN ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-0817
Practice Address - Country:US
Practice Address - Phone:715-417-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI638-228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health