Provider Demographics
NPI:1386875920
Name:HOUSE, COURTNEY PITNER (AUD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PITNER
Last Name:HOUSE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4730
Mailing Address - Country:US
Mailing Address - Phone:901-842-4327
Mailing Address - Fax:901-842-4330
Practice Address - Street 1:6242 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4730
Practice Address - Country:US
Practice Address - Phone:901-842-4327
Practice Address - Fax:901-842-4330
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I645934Medicare UPIN