Provider Demographics
NPI:1942656137
Name:DEY, KOURTNEY A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:A
Last Name:DEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1620
Mailing Address - Country:US
Mailing Address - Phone:918-919-3143
Mailing Address - Fax:918-544-6242
Practice Address - Street 1:17 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-3322
Practice Address - Country:US
Practice Address - Phone:918-919-3143
Practice Address - Fax:918-544-6242
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist