Courtney L Gibbs, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

9958 Issued in NC

Practice address

126 W Fremont St
Burgaw, NC 28425

Phone

(910) 663-5450

Fax

(844) 803-6048

NPI assigned

Jun 4, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pender Pediatric Therapy, PC

  • Speech-Language Pathologist
  • Burgaw, NC
  • NPI 1881136851
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1407117682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 W. FREMONT STREET",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "28425",
            "telephone_number": "910-663-5450",
            "fax_number": "844-803-6048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 W FREMONT ST",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "28425",
            "telephone_number": "910-663-5450",
            "fax_number": "844-803-6048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBS",
        "first_name": "COURTNEY",
        "middle_name": "L",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-04",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "9958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Froiseth, OTR/L
• Alisa Fussell
• Bianca Gangale, LCMHCA, NCC
• Kirsten Garay, LCSW
• Gustavo Gasca Jr., D.M.D.
• Justin Wade Gibson, LCSW, LCASA
• Hannah Suzanne Gould, SLPA
• Tonia Whitley Gray, NURSE PRACTITIONER
• Linda I Greenspan, D.O.
• Deborah Dawn Grim

• All providers in Burgaw, NC
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.