Provider Demographics
NPI:1407489388
Name:MCMULLEN, COURTNEY COLLEEN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:COLLEEN
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 N. COURT AVE
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720
Mailing Address - Country:US
Mailing Address - Phone:541-589-0273
Mailing Address - Fax:
Practice Address - Street 1:860 N. COURT AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720
Practice Address - Country:US
Practice Address - Phone:541-589-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR015023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty