Provider Demographics
NPI:1043041940
Name:CODD, SCARLETT (SLP)
Entity type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:CODD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 COMMONS DR W UNIT 1112
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8620
Mailing Address - Country:US
Mailing Address - Phone:504-450-0127
Mailing Address - Fax:
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 17
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5258
Practice Address - Country:US
Practice Address - Phone:850-200-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist