Provider Demographics
NPI:1619166584
Name:CORRIGALL, KATHERINE WAYE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WAYE
Last Name:CORRIGALL
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 1:15 HOLWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4418
Mailing Address - Country:US
Mailing Address - Phone:617-939-6333
Mailing Address - Fax:
Practice Address - Street 1:15 HOLWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4418
Practice Address - Country:US
Practice Address - Phone:617-939-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA305442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12086938OtherASHA
MESP1985OtherMAINE STATE LICENSURE
MA305442OtherMASS. STATE LICENSURE