Provider Demographics
NPI:1316326218
Name:CALKINS, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:CALKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 WOODGLEN LN APT 201
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4525
Mailing Address - Country:US
Mailing Address - Phone:630-709-5910
Mailing Address - Fax:
Practice Address - Street 1:8200 WOODGLEN LN APT 201
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4525
Practice Address - Country:US
Practice Address - Phone:630-709-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst