Provider Demographics
NPI:1063981744
Name:JUDSON, COURTNEY ALYSE (CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ALYSE
Last Name:JUDSON
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:ALYSE
Other - Last Name:BREHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:302 DARE RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3711 BIG BETHEL RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3812
Practice Address - Country:US
Practice Address - Phone:757-898-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist