Provider Demographics
NPI:1881717700
Name:SUTHERLAND, COURTNEY LEE (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:LEE
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 LICK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAYSI
Mailing Address - State:VA
Mailing Address - Zip Code:24256-5218
Mailing Address - Country:US
Mailing Address - Phone:276-865-0175
Mailing Address - Fax:276-865-0175
Practice Address - Street 1:3490 LICK CREEK RD
Practice Address - Street 2:
Practice Address - City:HAYSI
Practice Address - State:VA
Practice Address - Zip Code:24256-5218
Practice Address - Country:US
Practice Address - Phone:276-865-0175
Practice Address - Fax:276-865-0175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202004210OtherSPEECH-LANGUAGE PATHOLOGY