Provider Demographics
NPI:1235675778
Name:MENTIS, CORINNE ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:CORINNE
Middle Name:ELIZABETH
Last Name:MENTIS
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 1:17001 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3523
Mailing Address - Country:US
Mailing Address - Phone:216-267-2057
Mailing Address - Fax:
Practice Address - Street 1:17001 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3523
Practice Address - Country:US
Practice Address - Phone:216-485-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist