Provider Demographics
NPI:1346462199
Name:GIBBONS, COURTNAY ELIZABETH (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:COURTNAY
Middle Name:ELIZABETH
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:COURTNAY
Other - Middle Name:ELIZABETH
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:2431 S TROOST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2729
Mailing Address - Country:US
Mailing Address - Phone:918-494-1471
Mailing Address - Fax:918-494-1494
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:PHYSICAL MEDICINE
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-494-1471
Practice Address - Fax:918-494-1494
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist