Provider Demographics
NPI:1700472032
Name:WELDON, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:WELDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16025 S 50TH ST APT 2095
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-5015
Mailing Address - Country:US
Mailing Address - Phone:480-395-5863
Mailing Address - Fax:
Practice Address - Street 1:16025 S 50TH ST APT 2095
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-5015
Practice Address - Country:US
Practice Address - Phone:480-395-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ191011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical