Provider Demographics
NPI:1184397887
Name:COUNSELL, KODIE MARIE
Entity type:Individual
Prefix:
First Name:KODIE
Middle Name:MARIE
Last Name:COUNSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 W BETZ RD APT 24107
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-5284
Mailing Address - Country:US
Mailing Address - Phone:850-723-2443
Mailing Address - Fax:
Practice Address - Street 1:1106 WASHINGTON ST
Practice Address - Street 2:PE CLASSROOM BUILDING 200
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004
Practice Address - Country:US
Practice Address - Phone:509-359-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program