Provider Demographics
NPI:1538640172
Name:FARRELL, COURTNEY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:ZYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 416495
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6495
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:210 NORTH AVE E
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2491
Practice Address - Country:US
Practice Address - Phone:908-276-0237
Practice Address - Fax:908-276-5692
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01173900235Z00000X
FLSZ8704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist