Provider Demographics
NPI:1144553835
Name:KODY, CARLI BRAUN (PHD, LP)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:BRAUN
Last Name:KODY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COMMERCE DR STE 295
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9245
Mailing Address - Country:US
Mailing Address - Phone:651-272-9777
Mailing Address - Fax:
Practice Address - Street 1:700 COMMERCE DR STE 295
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9245
Practice Address - Country:US
Practice Address - Phone:651-272-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2022-07-21
Deactivation Date:2010-05-11
Deactivation Code:
Reactivation Date:2012-01-26
Provider Licenses
StateLicense IDTaxonomies
MNLP 5404103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist