Provider Demographics
NPI:1194079251
Name:MOSS, COURTNEY MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:MOSS
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 1:915 OXMOOR RD
Mailing Address - Street 2:#301
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5256
Mailing Address - Country:US
Mailing Address - Phone:229-347-5648
Mailing Address - Fax:
Practice Address - Street 1:915 OXMOOR RD
Practice Address - Street 2:#301
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5256
Practice Address - Country:US
Practice Address - Phone:229-347-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist