Healthcare Provider Details

I. General information

NPI: 1023378619
Provider Name (Legal Business Name): KORTNEY PRATER SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 OLD ALICE RD STE 600
BROWNSVILLE TX
78520-8274
US

IV. Provider business mailing address

606 MIKES BR
PIKEVILLE KY
41501-6433
US

V. Phone/Fax

Practice location:
  • Phone: 956-541-2102
  • Fax: 956-541-2502
Mailing address:
  • Phone: 606-434-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106330
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: