Provider Demographics
NPI:1033571468
Name:PENNEY, COURTNEY J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:J
Last Name:PENNEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4391 CENTENNIAL DR APT 174
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2656
Mailing Address - Country:US
Mailing Address - Phone:713-306-0067
Mailing Address - Fax:
Practice Address - Street 1:4391 CENTENNIAL DR APT 174
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2656
Practice Address - Country:US
Practice Address - Phone:713-306-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 11961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist