Provider Demographics
NPI:1124376405
Name:MCCOURRY, RALEEN A
Entity Type:Individual
Prefix:
First Name:RALEEN
Middle Name:A
Last Name:MCCOURRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 E WICKERSHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7550
Mailing Address - Country:US
Mailing Address - Phone:907-373-7700
Mailing Address - Fax:
Practice Address - Street 1:3600 E WICKERSHAM WAY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7550
Practice Address - Country:US
Practice Address - Phone:907-373-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK84237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist