Provider Demographics
NPI:1689302473
Name:REEVES, CORRINE (AUD)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WALTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1935
Mailing Address - Country:US
Mailing Address - Phone:573-756-0500
Mailing Address - Fax:573-756-0505
Practice Address - Street 1:1185 SCENIC DR STE 157
Practice Address - Street 2:
Practice Address - City:HERCULANEUM
Practice Address - State:MO
Practice Address - Zip Code:63048-1433
Practice Address - Country:US
Practice Address - Phone:573-756-0500
Practice Address - Fax:573-756-0505
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030615231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022030615OtherLICENSE