Provider Demographics
NPI:1447789177
Name:BROADFOOT, COURTNEY KUEHN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KUEHN
Last Name:BROADFOOT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:5721 USA DRIVE NORTH, HAHN 1119
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-0002
Practice Address - Country:US
Practice Address - Phone:251-445-9378
Practice Address - Fax:251-445-9377
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4461154235Z00000X
AL3987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist