Provider Demographics
NPI:1952587628
Name:CODY, WILLIAM PATRICK (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:CODY
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 SORRENTO DR
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-9447
Mailing Address - Country:US
Mailing Address - Phone:828-264-3746
Mailing Address - Fax:828-264-3746
Practice Address - Street 1:860 SORRENTO DR
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-9447
Practice Address - Country:US
Practice Address - Phone:828-264-3746
Practice Address - Fax:828-264-3746
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-12
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7423249Medicaid