Provider Demographics
NPI:1336966993
Name:WEDGEWORTH, CORI
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:
Last Name:WEDGEWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 72ND ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-5409
Mailing Address - Country:US
Mailing Address - Phone:205-641-0557
Mailing Address - Fax:
Practice Address - Street 1:716 72ND ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-5409
Practice Address - Country:US
Practice Address - Phone:205-641-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician