Provider Demographics
NPI:1083722995
Name:WEDGEWORTH, CORIE SUZANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CORIE
Middle Name:SUZANNE
Last Name:WEDGEWORTH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:CORINNE
Other - Middle Name:SUZANNE
Other - Last Name:WEDGEWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1517 LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-6122
Mailing Address - Country:US
Mailing Address - Phone:501-225-4935
Mailing Address - Fax:
Practice Address - Street 1:5312 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1852
Practice Address - Country:US
Practice Address - Phone:501-666-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist