Provider Demographics
NPI:1194157172
Name:AIVATI, COURTNEY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:AIVATI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:NARAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:8933 ACTIVITY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2600
Mailing Address - Country:US
Mailing Address - Phone:858-586-6823
Mailing Address - Fax:
Practice Address - Street 1:10243 GENETIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-526-6013
Practice Address - Fax:858-526-6062
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist