Individual
COURTNEY SHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1301 E YOUNG ST, LONGVIEW, TX 75602-2251
(903) 343-1650
Mailing address
1301 E YOUNG ST, LONGVIEW, TX 75602-2251
(903) 343-1650
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065702501
—
TX
Enumeration date
03/07/2022
Last updated
03/07/2022
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