Provider Demographics
NPI:1851051874
Name:ROMINE, COURTNEY L (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:ROMINE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11583 STATE HIGHWAY 60 S
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-3293
Mailing Address - Country:US
Mailing Address - Phone:979-241-1722
Mailing Address - Fax:
Practice Address - Street 1:128TH AVE H
Practice Address - Street 2:
Practice Address - City:VAN VLECK
Practice Address - State:TX
Practice Address - Zip Code:77482
Practice Address - Country:US
Practice Address - Phone:979-318-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist