Provider Demographics
NPI:1265595672
Name:GOUGER, COURTNEY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:GOUGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:KULIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1020 MARY ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1930
Mailing Address - Country:US
Mailing Address - Phone:315-724-6907
Mailing Address - Fax:
Practice Address - Street 1:10708 N GAGE RD
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2527
Practice Address - Country:US
Practice Address - Phone:315-896-2654
Practice Address - Fax:315-896-2717
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015154-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist