Provider Demographics
NPI:1033488127
Name:WALZ, COURTNEY E (HAD, ACA)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:E
Last Name:WALZ
Suffix:
Gender:F
Credentials:HAD, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N MARIETTA PKWY NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8023
Mailing Address - Country:US
Mailing Address - Phone:770-422-6644
Mailing Address - Fax:770-422-0685
Practice Address - Street 1:145 N MARIETTA PKWY NE
Practice Address - Street 2:SUITE E
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8023
Practice Address - Country:US
Practice Address - Phone:770-422-6644
Practice Address - Fax:770-422-0685
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHAD000860237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist