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General NPI Number Information
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NPI Number | 1609659481
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Entity Type | Individual
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Provider Name | KATHI BODILY MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 451 E 400 N WEST INSTRUCTION BLD, RM 120
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City | PRICE
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State | UT
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Zip | 84501
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Country | US
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Telephone | 435-613-5012
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Fax |
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Provider Business Mailing Address
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Address Line | 2117 N DAKOTA AVE
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City | AMES
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State | IA
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Zip | 50014-9016
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Country | US
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Telephone | 435-979-1868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 096031
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4904
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 9828347-4102
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License Number State | UT
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