Provider Demographics
NPI:1689036725
Name:DELORENZO, COURTNEY J
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:J
Last Name:DELORENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:DELORENZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-0248
Mailing Address - Country:US
Mailing Address - Phone:518-275-6501
Mailing Address - Fax:
Practice Address - Street 1:2 STATE LINE RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:W STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01266
Practice Address - Country:US
Practice Address - Phone:518-275-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist