Provider Demographics
NPI:1356840789
Name:SLOCUM, COURTNEY M (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:M
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:5041 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1433
Mailing Address - Country:US
Mailing Address - Phone:513-832-2884
Mailing Address - Fax:
Practice Address - Street 1:5041 OAKLAWN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1433
Practice Address - Country:US
Practice Address - Phone:513-832-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-16-21926103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst