Provider Demographics
NPI:1114160124
Name:ADAMS, COURTNEY ANN (MCD,CCC-A)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MCD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 709
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-7735
Mailing Address - Fax:225-765-1023
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:STE 709
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-7735
Practice Address - Fax:225-765-1023
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5686231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1562963Medicaid
LA5V151CW42Medicare PIN