Doctor Name: | MRS. COURTNEY MARIE BANISTER |
NPI Number: | 1033456033 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1187 |
Business Practice Address: | 5550 44th Ave S Fargo, ND - 581044349 |
Business Phone Number: | 7014996646 |
Business Fax Number: | |
Mailing Address: | 1134 44th Ave W, WEST FARGO |
State: | ND |
Postal Code: | 580788836 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/10/2013 |
NPI Last Update Date: | 01/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1187 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |