Provider Demographics
NPI:1235672064
Name:CORN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 CHAPEL HILL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5079
Mailing Address - Country:US
Mailing Address - Phone:919-610-9298
Mailing Address - Fax:844-587-9553
Practice Address - Street 1:7424 CHAPEL HILL RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5079
Practice Address - Country:US
Practice Address - Phone:919-610-9298
Practice Address - Fax:844-587-9553
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist