Provider Demographics
NPI:1033596713
Name:CORIE, JENNIFER SALGO (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SALGO
Last Name:CORIE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 ROBIN CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6037
Mailing Address - Country:US
Mailing Address - Phone:601-818-3501
Mailing Address - Fax:
Practice Address - Street 1:822 ROBIN CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6037
Practice Address - Country:US
Practice Address - Phone:601-818-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2022-02-02
Deactivation Date:2021-12-21
Deactivation Code:
Reactivation Date:2022-02-02
Provider Licenses
StateLicense IDTaxonomies
LA7336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03983019Medicaid
LA488818YH3VMedicare PIN