Active NPI
Kodee Walls, PHD
- Counseling Psychologist
- Bloomington, IN
National Provider Identifier
1053099754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 2547
- Practice address
- 600 N Eagleson Ave
Bloomington, IN 47405-3190 - Phone
- (812) 855-5711
- NPI assigned
- Jul 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 2547 | KS | Primary |
Addresses
Primary practice location
600 N Eagleson Ave
Bloomington, IN 47405-3190
Mailing address
1209 E Chestnut CT
Bloomington, IN 47401-6650
Phone (785) 209-2914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2547 | KS | MD | Speech-Language Pathologist |
Interoperability endpoints
- kodee.walls@iushc.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689033600000",
"number": "1053099754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 E CHESTNUT CT",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474016650",
"telephone_number": "785-209-2914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N EAGLESON AVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053190",
"telephone_number": "812-855-5711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLS",
"first_name": "KODEE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-11",
"last_updated": "2023-07-11",
"certification_date": "2023-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "KS",
"license": "2547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.