Provider Demographics
NPI:1578807129
Name:CORDNER, ALICIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CORDNER
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 1:144 PAULS PATH
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3324
Mailing Address - Country:US
Mailing Address - Phone:631-678-3362
Mailing Address - Fax:
Practice Address - Street 1:144 PAULS PATH
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3324
Practice Address - Country:US
Practice Address - Phone:631-678-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist