Provider Demographics
NPI:1902799703
Name:ERVIN, CODY LEE (MSLP, CF-SLP)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:ERVIN
Suffix:
Gender:M
Credentials:MSLP, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 POND APPLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2208
Mailing Address - Country:US
Mailing Address - Phone:931-920-4333
Mailing Address - Fax:
Practice Address - Street 1:461 POND APPLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2208
Practice Address - Country:US
Practice Address - Phone:931-920-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist