Provider Demographics
NPI:1265147219
Name:SWEENEY, CODY KENNETH (LPC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:KENNETH
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 W PERSHING ST APT 22
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6038
Mailing Address - Country:US
Mailing Address - Phone:715-412-2401
Mailing Address - Fax:
Practice Address - Street 1:2459 W PERSHING ST APT 22
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-6038
Practice Address - Country:US
Practice Address - Phone:715-412-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI10725-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health