Provider Demographics
NPI:1457629131
Name:NELSON, CORINNE MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 FRUITLAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7132
Mailing Address - Country:US
Mailing Address - Phone:425-308-7302
Mailing Address - Fax:
Practice Address - Street 1:3111 NEWMARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8695
Practice Address - Country:US
Practice Address - Phone:425-308-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14035915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist