Provider Demographics
NPI:1689238164
Name:JASON, COURTNEY THOMAS (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:THOMAS
Last Name:JASON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LEAFCUP CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2632
Mailing Address - Country:US
Mailing Address - Phone:484-947-7331
Mailing Address - Fax:
Practice Address - Street 1:109 LEAFCUP CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2632
Practice Address - Country:US
Practice Address - Phone:484-947-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist