Provider Demographics
NPI:1902201825
Name:BODKIN, COURTNEY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:BODKIN
Suffix:
Gender:F
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 1:900 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4909
Mailing Address - Country:US
Mailing Address - Phone:614-899-2838
Mailing Address - Fax:614-899-2876
Practice Address - Street 1:939 S STATE ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3346
Practice Address - Country:US
Practice Address - Phone:614-865-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist