Individual
DR. CODIE JORDAN VASSAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4006 WASHINGTON RD, KENOSHA, WI 53144-4819
(262) 656-0044
(262) 885-6340
Mailing address
4006 WASHINGTON RD, KENOSHA, WI 53144-4819
(262) 656-4400
(262) 649-1977
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01088491A
IN
2084P0800X
Psychiatry Physician
036159195
IL
2084P0800X
Psychiatry Physician
2023032985
MO
2084P0800X
Psychiatry Physician
327809-01
NY
2084P0800X
Psychiatry Physician
Primary
6978320
WI
2084P0800X
Psychiatry Physician
A182671
CA
2084P0800X
Psychiatry Physician
ME165983
FL
2084P0800X
Psychiatry Physician
T8967
TX
2084P0800X
Psychiatry Physician
T8967
WI
208D00000X
General Practice Physician
6978320
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100005776
—
WI
Enumeration date
03/27/2017
Last updated
07/24/2026
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