Provider Demographics
NPI:1457248486
Name:FEDOR, COURTNEY GEORGEANNE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GEORGEANNE
Last Name:FEDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 SE BETHEL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5606
Mailing Address - Country:US
Mailing Address - Phone:360-801-5527
Mailing Address - Fax:
Practice Address - Street 1:1451 SE BETHEL VALLEY LN
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5606
Practice Address - Country:US
Practice Address - Phone:360-801-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst