Provider Demographics
NPI:1487957106
Name:CHASE, CODY CHARLES (MSW)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:CHARLES
Last Name:CHASE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 W 6TH
Mailing Address - Street 2:
Mailing Address - City:KENNEWIDK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:541-922-6226
Mailing Address - Fax:
Practice Address - Street 1:290 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-6601
Practice Address - Country:US
Practice Address - Phone:541-922-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health