Provider Demographics
NPI:1780677260
Name:MEYER, COURTLAND GUNN (MED CCCSLP CED)
Entity Type:Individual
Prefix:MRS
First Name:COURTLAND
Middle Name:GUNN
Last Name:MEYER
Suffix:
Gender:F
Credentials:MED CCCSLP CED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-9325
Mailing Address - Country:US
Mailing Address - Phone:540-483-3661
Mailing Address - Fax:
Practice Address - Street 1:MCNULTY CENTER FOR CHILDREN AND FAMILIES
Practice Address - Street 2:463 E WASHINGTON ST
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-433-3100
Practice Address - Fax:540-433-8277
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137468OtherANTHEM