MEDICARE: COURTNEY THOMPSON M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3809	OK

General Provider Information

NPI Number	:	1942734819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY THOMPSON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	60 MERGANSER LN
Second Line	:
City	:	GARVIN
State	:	OK
Zip	:	74736-5022
Country	:	US
Telephone Number	:	580-212-7180
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 MERGANSER LN
Second Line	:
City	:	GARVIN
State	:	OK
Zip	:	74736-5022
Country	:	US
Telephone Number	:	580-212-7180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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Directions to “ COURTNEY THOMPSON M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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