Provider Demographics
NPI:1811540529
Name:THOMAS, COURTNEY LEIGH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LEIGH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:EDGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20104 ARSENAL STREET RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5560
Mailing Address - Country:US
Mailing Address - Phone:315-779-7000
Mailing Address - Fax:
Practice Address - Street 1:20104 ARSENAL STREET RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5560
Practice Address - Country:US
Practice Address - Phone:315-779-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist