Provider Demographics
NPI:1346815941
Name:DUMOUCHELLE, COURTNEY LYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYN
Last Name:DUMOUCHELLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LYN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:540 D AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1290
Mailing Address - Country:US
Mailing Address - Phone:574-333-9402
Mailing Address - Fax:
Practice Address - Street 1:627 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1040
Practice Address - Country:US
Practice Address - Phone:616-447-7799
Practice Address - Fax:616-724-4117
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist