Provider Demographics
NPI:1124381678
Name:BAKAN, COURTNEY A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:BAKAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:SMARANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3507 BLACKBURN RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3205
Mailing Address - Country:US
Mailing Address - Phone:330-224-9523
Mailing Address - Fax:
Practice Address - Street 1:2550 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3306
Practice Address - Country:US
Practice Address - Phone:330-456-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND. 2012244-SP235Z00000X
OHSP.10788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist