Provider Demographics
NPI:1780725440
Name:RICHARDSON-YOUNG, COURTNEY ROAN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ROAN
Last Name:RICHARDSON-YOUNG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9506 APPLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7553
Mailing Address - Country:US
Mailing Address - Phone:502-243-9362
Mailing Address - Fax:
Practice Address - Street 1:4212 CHARLESTOWN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9487
Practice Address - Country:US
Practice Address - Phone:812-949-3272
Practice Address - Fax:812-949-3271
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003339A235Z00000X
KY2040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist