Basic Information
| Provider Information | |||||||||
| NPI: | 1780677260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | COURTLAND | ||||||||
| MiddleName: | GUNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MED CCCSLP CED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3071 BROOKSTONE DR | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228019325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404833661 | ||||||||
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| Practice Location | |||||||||
| Address1: | MCNULTY CENTER FOR CHILDREN AND FAMILIES | ||||||||
| Address2: | 463 E WASHINGTON ST | ||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404333100 | ||||||||
| FaxNumber: | 5404338277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202001289 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 137468 | 01 | VA | ANTHEM | OTHER |