Provider Demographics
NPI:1982376976
Name:DEW, CODY WYATT
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:WYATT
Last Name:DEW
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 1:5337 STATE ROUTE 26 LOT 19
Mailing Address - Street 2:
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862-1946
Mailing Address - Country:US
Mailing Address - Phone:419-704-9973
Mailing Address - Fax:
Practice Address - Street 1:2496 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITNEY POINT
Practice Address - State:NY
Practice Address - Zip Code:13862-1811
Practice Address - Country:US
Practice Address - Phone:607-692-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist