Provider Demographics
NPI:1508385691
Name:CLOUGH KAEDING, CORINNE MARIE
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:MARIE
Last Name:CLOUGH KAEDING
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 1:2317 HACKBERRY CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6217
Mailing Address - Country:US
Mailing Address - Phone:217-649-2302
Mailing Address - Fax:
Practice Address - Street 1:2317 HACKBERRY CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-6217
Practice Address - Country:US
Practice Address - Phone:217-649-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency