MEDICARE: ADRIA JEAN CODISPOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33434286	OTHER	PA	DRIVERSLICENSE

General Provider Information

NPI Number	:	1760332936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIA JEAN CODISPOT

Provider Business Mailing Address
First Line	:	111 PINEVIEW RD
Second Line	:
City	:	BADEN
State	:	PA
Zip	:	15005-9667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11676 PERRY HWY STE 2100
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7203
Country	:	US
Telephone Number	:	724-934-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ ADRIA JEAN CODISPOT ” Practice Location

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