Provider Demographics
NPI:1700572526
Name:BEHRENS, CODY WAYNE
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:WAYNE
Last Name:BEHRENS
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 1:1815 W MARKET ST STE 102
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7018
Mailing Address - Country:US
Mailing Address - Phone:352-223-5914
Mailing Address - Fax:
Practice Address - Street 1:1815 W MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7018
Practice Address - Country:US
Practice Address - Phone:352-223-5914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator