Provider Demographics
NPI:1649436072
Name:ROSS, COURTNEY LEIGH (AUD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LEIGH
Last Name:ROSS
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 1:8575 FERN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5677
Mailing Address - Country:US
Mailing Address - Phone:318-798-0759
Mailing Address - Fax:318-798-0765
Practice Address - Street 1:8575 FERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5677
Practice Address - Country:US
Practice Address - Phone:318-798-0759
Practice Address - Fax:318-798-0765
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5857231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist