Provider Demographics
NPI:1871147025
Name:COURTNEY L. SUTHERLAND M.S. CCC-SLP, LLC
Entity type:Organization
Organization Name:COURTNEY L. SUTHERLAND M.S. CCC-SLP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-492-4457
Mailing Address - Street 1:170 COLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:NORA
Mailing Address - State:VA
Mailing Address - Zip Code:24272-7152
Mailing Address - Country:US
Mailing Address - Phone:276-337-1032
Mailing Address - Fax:
Practice Address - Street 1:170 COLD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:NORA
Practice Address - State:VA
Practice Address - Zip Code:24272-7152
Practice Address - Country:US
Practice Address - Phone:276-337-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COURTNEY L. SUTHERLAND M.S. CCC-SLP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty