Provider Demographics
NPI:1043586936
Name:CORSON, KATHERINE (CFY-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:CORSON
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3936
Mailing Address - Country:US
Mailing Address - Phone:317-828-8203
Mailing Address - Fax:
Practice Address - Street 1:10921 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-3936
Practice Address - Country:US
Practice Address - Phone:317-828-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist