Provider Demographics
NPI:1396023602
Name:CORBIN, DANIELLE GLENN (AUD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:GLENN
Last Name:CORBIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:GLENN
Other - Last Name:GAUTREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:131 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3341
Mailing Address - Country:US
Mailing Address - Phone:410-535-6975
Mailing Address - Fax:410-535-6915
Practice Address - Street 1:131 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3341
Practice Address - Country:US
Practice Address - Phone:410-535-6975
Practice Address - Fax:410-535-6915
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01477231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist