Provider Demographics
NPI:1770919441
Name:SIMANSKI, COURTNEY ANN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:SIMANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:BERNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 4TH ST. N.
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-446-1014
Mailing Address - Fax:701-446-1200
Practice Address - Street 1:415 4TH ST. N.
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-446-1014
Practice Address - Fax:701-446-1200
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
ND1332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1454987Medicaid