Provider Demographics
NPI:1568471399
Name:CORBIN, KIM CAFFEY (CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:CAFFEY
Last Name:CORBIN
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 1:6673 HIGHWAY 322 E
Mailing Address - Street 2:
Mailing Address - City:LAMBERT
Mailing Address - State:MS
Mailing Address - Zip Code:38643-8473
Mailing Address - Country:US
Mailing Address - Phone:662-326-5580
Mailing Address - Fax:662-326-2550
Practice Address - Street 1:6673 HIGHWAY 322 E
Practice Address - Street 2:
Practice Address - City:LAMBERT
Practice Address - State:MS
Practice Address - Zip Code:38643-8473
Practice Address - Country:US
Practice Address - Phone:662-326-5580
Practice Address - Fax:662-326-2550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist