Provider Demographics
NPI:1649762725
Name:AUFMUTH, CORISA (MSED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORISA
Middle Name:
Last Name:AUFMUTH
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:CORISA
Other - Middle Name:
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED CCC-SLP
Mailing Address - Street 1:180 CAMPBELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-4847
Mailing Address - Country:US
Mailing Address - Phone:607-643-2365
Mailing Address - Fax:
Practice Address - Street 1:21 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1459
Practice Address - Country:US
Practice Address - Phone:607-643-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist