Courtney Sanocki

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

TSLP10264 Issued in AZ

Practice address

1891 Station Pkwy NW
Andover, MN 55304

Phone

(763) 755-4275

NPI assigned

Dec 9, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Courtney Staudacher Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Milemarkers Therapy

  • Speech-Language Pathologist
  • Lake Havasu City, AZ
  • NPI 1215487376
  NPD (past)
• Milemarkers Therapy

  • Occupational Therapist
  • Lake Havasu City, AZ
  • NPI 1336594951
  NPD (past)

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1497299499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043341",
            "telephone_number": "763-755-4275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "55304",
            "telephone_number": "763-755-4275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2495 Maplewood Dr Ste 313",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "55109",
            "country_code": "US",
            "telephone_number": "651-770-8884",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1515 Lake Havasu Ave N",
            "address_purpose": "LOCATION",
            "city": "Lake Havasu City",
            "state": "AZ",
            "postal_code": "864041177",
            "country_code": "US",
            "telephone_number": "928-854-5439",
            "fax_number": "928-854-5440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANOCKI",
        "first_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-09",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "TSLP10264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497299499",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "819797",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "STAUDACHER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Andover, MN
• Providers in Andover, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.