Provider Demographics
NPI:1730651530
Name:FERNANDES, COURTNEY A
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 W BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8842
Mailing Address - Country:US
Mailing Address - Phone:414-231-0919
Mailing Address - Fax:
Practice Address - Street 1:1820 PINE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3750
Practice Address - Country:US
Practice Address - Phone:608-785-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor