Provider Demographics
NPI:1609183797
Name:GODWIN, COURTNEY ELIZABETH (MS)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LILLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3130
Mailing Address - Country:US
Mailing Address - Phone:980-225-5414
Mailing Address - Fax:980-225-5414
Practice Address - Street 1:316 LILLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3130
Practice Address - Country:US
Practice Address - Phone:980-225-5414
Practice Address - Fax:980-225-5414
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist