Provider Demographics
NPI:1598289696
Name:CORNING, MAX ELDREDGE II (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:ELDREDGE
Last Name:CORNING
Suffix:II
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 E 126TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9404
Mailing Address - Country:US
Mailing Address - Phone:317-436-8961
Mailing Address - Fax:317-991-1593
Practice Address - Street 1:9929 E 126TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-9404
Practice Address - Country:US
Practice Address - Phone:317-436-8961
Practice Address - Fax:317-991-1593
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006431A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22006431AOtherSTATE LICENSE