Provider Demographics
NPI:1831836592
Name:STRANAK, COURTNEY PRISCILLA (MED)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PRISCILLA
Last Name:STRANAK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N GOVERNMENT WAY # 103
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-3751
Mailing Address - Country:US
Mailing Address - Phone:208-277-8186
Mailing Address - Fax:
Practice Address - Street 1:3530 W VELA PL # A
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8827
Practice Address - Country:US
Practice Address - Phone:208-277-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAD000722Q106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician