Provider Demographics
NPI:1710284401
Name:HAYES, COURTNEY (SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 AVINGTON GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3540
Mailing Address - Country:US
Mailing Address - Phone:678-362-0526
Mailing Address - Fax:
Practice Address - Street 1:1319 AVINGTON GLEN DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3540
Practice Address - Country:US
Practice Address - Phone:678-362-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist