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General NPI Number Information
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NPI Number | 1275181463
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Entity Type | Individual
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Provider Name | COURTNEY HARRISON
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Gender | Female
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 4614 WAVERLY RD
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City | HUNTINGTON
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State | WV
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Zip | 25704-1039
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Country | US
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Telephone | 304-429-3287
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 CHESTNUT ST
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City | KENOVA
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State | WV
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Zip | 25530-1235
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Country | US
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Telephone | 304-453-2353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PSLP0817
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License Number State | WV
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