Provider Demographics
NPI:1154730711
Name:WARD, COURTNEY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 TISHOMINGO LN
Mailing Address - Street 2:GUESTHOUSE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2627
Mailing Address - Country:US
Mailing Address - Phone:609-214-9878
Mailing Address - Fax:
Practice Address - Street 1:2904 TISHOMINGO LN
Practice Address - Street 2:GUESTHOUSE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2627
Practice Address - Country:US
Practice Address - Phone:609-214-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist