Provider Demographics
NPI:1508504697
Name:TALBERT, CORRIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:TALBERT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 E BULLARD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5455
Mailing Address - Country:US
Mailing Address - Phone:559-205-0930
Mailing Address - Fax:559-899-3123
Practice Address - Street 1:670 E BULLARD AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5455
Practice Address - Country:US
Practice Address - Phone:559-205-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist