Provider Demographics
NPI:1033765995
Name:CARR, KOURTNEY (MS SLP)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:806 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-323-4028
Mailing Address - Fax:701-323-4027
Practice Address - Street 1:806 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-323-4028
Practice Address - Fax:701-323-4027
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist