Provider Demographics
NPI:1639741010
Name:STAFFY, KANSAS COURTNEY
Entity Type:Individual
Prefix:
First Name:KANSAS
Middle Name:COURTNEY
Last Name:STAFFY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANSAS
Other - Middle Name:COURTNEY
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10605 BLUE LARKSPUR CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8546
Mailing Address - Country:US
Mailing Address - Phone:210-848-9584
Mailing Address - Fax:
Practice Address - Street 1:8670 W CHEYENNE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7457
Practice Address - Country:US
Practice Address - Phone:725-202-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist