Provider Demographics
NPI:1851704779
Name:COURTNEY, DEIRDRE L (AUD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:L
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 E JOPPA RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3386
Mailing Address - Country:US
Mailing Address - Phone:410-944-3100
Mailing Address - Fax:866-253-2466
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4280
Practice Address - Country:US
Practice Address - Phone:107-604-3274
Practice Address - Fax:866-253-2466
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01322231HA2400X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01322OtherLICENSE