Healthcare Provider Details

I. General information

NPI: 1225608839
Provider Name (Legal Business Name): EMILY ANNE BODISH DR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W RANDOL MILL RD STE 100
ARLINGTON TX
76011-5810
US

IV. Provider business mailing address

101 W RANDOL MILL RD STE 100
ARLINGTON TX
76011-5810
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-7039
  • Fax:
Mailing address:
  • Phone: 817-277-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: