Provider Demographics
NPI:1942677604
Name:HERRICK, CODY LELAND (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:LELAND
Last Name:HERRICK
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 TUDOR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1643
Mailing Address - Country:US
Mailing Address - Phone:907-575-6776
Mailing Address - Fax:
Practice Address - Street 1:2081 TUDOR HILLS DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1643
Practice Address - Country:US
Practice Address - Phone:907-575-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist