Provider Demographics
NPI:1386947786
Name:WARNER, KORTNEE PAIGE MOORE (CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:KORTNEE
Middle Name:PAIGE MOORE
Last Name:WARNER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N328 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-9314
Mailing Address - Country:US
Mailing Address - Phone:608-434-1679
Mailing Address - Fax:
Practice Address - Street 1:N328 3RD AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9314
Practice Address - Country:US
Practice Address - Phone:608-434-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3361-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist