Provider Demographics
NPI:1417189952
Name:SHEPARD, COURTNEY E (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:SHEPARD
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 1:214 NORWALK AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2442
Mailing Address - Country:US
Mailing Address - Phone:716-844-8952
Mailing Address - Fax:
Practice Address - Street 1:25 CHATEAU TER
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3927
Practice Address - Country:US
Practice Address - Phone:716-839-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019308-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist