Healthcare Provider Details

I. General information

NPI: 1376795062
Provider Name (Legal Business Name): COURTNEY H. MILFORD M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY HOLDERLE M.S.

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5484 MISSION RD
CONESUS NY
14435-9587
US

IV. Provider business mailing address

5484 MISSION RD
CONESUS NY
14435-9587
US

V. Phone/Fax

Practice location:
  • Phone: 585-727-3319
  • Fax:
Mailing address:
  • Phone: 585-727-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number018401-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: