Healthcare Provider Details

I. General information

NPI: 1518795459
Provider Name (Legal Business Name): COURTNEY MARTINEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY OSWALD

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3086 W MILANO DR
MERIDIAN ID
83646-7288
US

IV. Provider business mailing address

3086 W MILANO DR
MERIDIAN ID
83646-7288
US

V. Phone/Fax

Practice location:
  • Phone: 208-996-0552
  • Fax:
Mailing address:
  • Phone: 208-996-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9961464
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: