Provider Demographics
NPI:1689325961
Name:COURTNEY'S COMMUNICATION STATION
Entity Type:Organization
Organization Name:COURTNEY'S COMMUNICATION STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-640-4641
Mailing Address - Street 1:77 BEDFORD ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1909
Mailing Address - Country:US
Mailing Address - Phone:347-640-4641
Mailing Address - Fax:
Practice Address - Street 1:77 BEDFORD ST APT 2B
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1909
Practice Address - Country:US
Practice Address - Phone:347-640-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty