Provider Demographics
NPI:1376235077
Name:TALLMAN, CORINE (HIS)
Entity Type:Individual
Prefix:
First Name:CORINE
Middle Name:
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-2093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 PRUITT RIDGE RD
Practice Address - Street 2:
Practice Address - City:HESTAND
Practice Address - State:KY
Practice Address - Zip Code:42151-5059
Practice Address - Country:US
Practice Address - Phone:270-407-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270694237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist