Provider Demographics
NPI:1952166035
Name:DODD, NYA SIMONE
Entity type:Individual
Prefix:
First Name:NYA
Middle Name:SIMONE
Last Name:DODD
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 1:2907 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9142
Mailing Address - Country:US
Mailing Address - Phone:417-633-8692
Mailing Address - Fax:
Practice Address - Street 1:13440 N CALDWELL RD
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255-4012
Practice Address - Country:US
Practice Address - Phone:573-289-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician