Provider Demographics
NPI:1629743679
Name:ANDERSON, KOURTNEY MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KOURTNEY
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 E COUNTY ROAD 600 S
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-9558
Mailing Address - Country:US
Mailing Address - Phone:812-528-8255
Mailing Address - Fax:
Practice Address - Street 1:1004 E COUNTY ROAD 600 S
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-9558
Practice Address - Country:US
Practice Address - Phone:812-528-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003828A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist