Provider Demographics
NPI:1912143348
Name:HALLAHAN, COURTNEY ELLEN (MSED- SLP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ELLEN
Last Name:HALLAHAN
Suffix:
Gender:F
Credentials:MSED- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 WINDSOR XING
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2621
Mailing Address - Country:US
Mailing Address - Phone:315-212-2939
Mailing Address - Fax:
Practice Address - Street 1:1605 WINDSOR XING
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2621
Practice Address - Country:US
Practice Address - Phone:315-212-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018524-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist