Provider Demographics
NPI:1508322124
Name:GRASS, CORINNE (SLP)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:GRASS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:MCGOWND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 COUNTY ROAD 43200
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-5125
Mailing Address - Country:US
Mailing Address - Phone:314-422-6462
Mailing Address - Fax:
Practice Address - Street 1:457 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5645
Practice Address - Country:US
Practice Address - Phone:757-271-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114526235Z00000X
VA2202011222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist