Healthcare Provider Details

I. General information

NPI: 1992676365
Provider Name (Legal Business Name): COURTNEY ESCUDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 CHERRY RD
ROCK HILL SC
29732-2616
US

IV. Provider business mailing address

24 GREENWICH BLVD APT 107
CLOVER SC
29710-7809
US

V. Phone/Fax

Practice location:
  • Phone: 803-792-0771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: