Provider Demographics
NPI:1659708683
Name:NORTHUP, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:NORTHUP
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 1:1258 W SOUTH JORDAN PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4712
Mailing Address - Country:US
Mailing Address - Phone:801-255-1155
Mailing Address - Fax:801-255-0281
Practice Address - Street 1:1258 W SOUTH JORDAN PKWY STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4712
Practice Address - Country:US
Practice Address - Phone:801-255-1155
Practice Address - Fax:801-255-0281
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8821816-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical