Provider Demographics
NPI:1326357112
Name:NEAL, CORBAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORBAN
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CORBAN
Other - Middle Name:
Other - Last Name:CURTISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4428 PHEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5219
Mailing Address - Country:US
Mailing Address - Phone:540-400-6430
Mailing Address - Fax:
Practice Address - Street 1:4428 PHEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5219
Practice Address - Country:US
Practice Address - Phone:540-400-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9718235Z00000X
VA2202006853235Z00000X
MD06614235Z00000X
NH1399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist