Healthcare Provider Details

I. General information

NPI: 1639741010
Provider Name (Legal Business Name): KANSAS COURTNEY STAFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KANSAS COURTNEY MERRITT

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W UNIVERSITY DR
MESA AZ
85201-5818
US

IV. Provider business mailing address

16749 W WASHINGTON ST
GOODYEAR AZ
85338-4530
US

V. Phone/Fax

Practice location:
  • Phone: 480-668-1917
  • Fax:
Mailing address:
  • Phone: 210-848-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP17021
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.0005847
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: