Provider Demographics
NPI:1568977056
Name:CLEMENTS, CORINDA RAE
Entity Type:Individual
Prefix:
First Name:CORINDA
Middle Name:RAE
Last Name:CLEMENTS
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 1:633 E SIOUX AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3368
Mailing Address - Country:US
Mailing Address - Phone:605-224-8848
Mailing Address - Fax:605-224-7870
Practice Address - Street 1:633 E SIOUX AVE STE 1
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3368
Practice Address - Country:US
Practice Address - Phone:605-224-8848
Practice Address - Fax:605-224-7870
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD467H237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter