Provider Demographics
NPI:1962922773
Name:SMITH, COURTNEY LYNN (STUDENT HIS)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:STUDENT HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E SPRINGHILL DR STE C
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4439
Mailing Address - Country:US
Mailing Address - Phone:812-237-0099
Mailing Address - Fax:812-237-0097
Practice Address - Street 1:500 E SPRINGHILL DR STE C
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4439
Practice Address - Country:US
Practice Address - Phone:812-237-0099
Practice Address - Fax:812-237-0097
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN40002781A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty