Provider Demographics
NPI:1255090973
Name:SPATES, COURTNEY LEIGH (MS)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LEIGH
Last Name:SPATES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MR
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:PERKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8510 BELL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3826
Mailing Address - Country:US
Mailing Address - Phone:804-543-9505
Mailing Address - Fax:
Practice Address - Street 1:8510 BELL CREEK RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3826
Practice Address - Country:US
Practice Address - Phone:804-543-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist