Provider Demographics
NPI:1205325271
Name:COURTNEY, ASHLEY ODECIA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ODECIA
Last Name:COURTNEY
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 1:410 N RONEY ST
Mailing Address - Street 2:
Mailing Address - City:CARL JUNCTION
Mailing Address - State:MO
Mailing Address - Zip Code:64834-9751
Mailing Address - Country:US
Mailing Address - Phone:417-669-1789
Mailing Address - Fax:
Practice Address - Street 1:410 N RONEY ST
Practice Address - Street 2:
Practice Address - City:CARL JUNCTION
Practice Address - State:MO
Practice Address - Zip Code:64834-9751
Practice Address - Country:US
Practice Address - Phone:417-669-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator