Provider Demographics
NPI:1982263406
Name:MCCOURT, MICHELE LEE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 NE ANNA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2498
Mailing Address - Country:US
Mailing Address - Phone:973-886-4480
Mailing Address - Fax:
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4753
Practice Address - Country:US
Practice Address - Phone:973-886-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist