Provider Demographics
NPI:1457575771
Name:CODLING, VAIL (LCSW)
Entity type:Individual
Prefix:MR
First Name:VAIL
Middle Name:
Last Name:CODLING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 N 2000 E
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-5318
Mailing Address - Country:US
Mailing Address - Phone:208-624-3199
Mailing Address - Fax:
Practice Address - Street 1:631 N 200 E
Practice Address - Street 2:SUITE 1
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3599
Practice Address - Country:US
Practice Address - Phone:208-356-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-248851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical