Provider Demographics
NPI:1063573624
Name:NUCKOLS, COURTNEY MCMANUS (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MCMANUS
Last Name:NUCKOLS
Suffix:
Gender:F
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 1:333 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-8664
Mailing Address - Country:US
Mailing Address - Phone:859-879-0051
Mailing Address - Fax:859-226-0899
Practice Address - Street 1:333 S HILL RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-8664
Practice Address - Country:US
Practice Address - Phone:859-879-0051
Practice Address - Fax:859-226-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist