Provider Demographics
NPI:1154453868
Name:CORSO, KERRY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:CORSO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2125
Mailing Address - Country:US
Mailing Address - Phone:301-654-1666
Mailing Address - Fax:301-654-7175
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1528
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-654-1666
Practice Address - Fax:301-654-7175
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist