Provider Demographics
NPI:1407328131
Name:CORVELLO, BRITTANY LORRAINE
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LORRAINE
Last Name:CORVELLO
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 1:1 LYNX LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3323
Mailing Address - Country:US
Mailing Address - Phone:916-849-7185
Mailing Address - Fax:
Practice Address - Street 1:19241 DAVID MEMORIAL DR STE 170A
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8786
Practice Address - Country:US
Practice Address - Phone:936-321-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist