Provider Demographics
NPI:1154130615
Name:TEMPLE, COURTNEY MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 BUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2917
Mailing Address - Country:US
Mailing Address - Phone:765-591-4190
Mailing Address - Fax:
Practice Address - Street 1:1912 BUNDY AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2917
Practice Address - Country:US
Practice Address - Phone:765-591-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22008735A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist