Provider Demographics
NPI:1639765506
Name:PORTER, COURTNEY LOUISE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LOUISE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LOUISE
Other - Last Name:SIEBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:1800 W IRISH LN
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1020
Mailing Address - Country:US
Mailing Address - Phone:660-687-0187
Mailing Address - Fax:660-687-0221
Practice Address - Street 1:210 S 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2172
Practice Address - Country:US
Practice Address - Phone:660-885-2394
Practice Address - Fax:660-383-1650
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020013733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist