Provider Demographics
NPI:1124553193
Name:PHIPPS, CORRIE DEANN (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:DEANN
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ECONOME CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4870
Mailing Address - Country:US
Mailing Address - Phone:916-300-2032
Mailing Address - Fax:
Practice Address - Street 1:112 ECONOME CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4870
Practice Address - Country:US
Practice Address - Phone:916-300-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant