Provider Demographics
NPI:1033475710
Name:STANISZEWSKI, CORRIE PHARES (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:PHARES
Last Name:STANISZEWSKI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:CORRIE
Other - Middle Name:LYNN
Other - Last Name:PHARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:25714 MILL POND LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-3144
Mailing Address - Country:US
Mailing Address - Phone:832-338-5120
Mailing Address - Fax:
Practice Address - Street 1:25714 MILL POND LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-3144
Practice Address - Country:US
Practice Address - Phone:832-338-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist