Provider Demographics
NPI:1760500482
Name:WILCOX, CORRY L (MA)
Entity Type:Individual
Prefix:MS
First Name:CORRY
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 RIVER VALLEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1669
Mailing Address - Country:US
Mailing Address - Phone:740-654-3571
Mailing Address - Fax:740-689-3277
Practice Address - Street 1:1303 RIVER VALLEY BLVD STE B
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1669
Practice Address - Country:US
Practice Address - Phone:740-654-3571
Practice Address - Fax:740-689-3277
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01182231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2104681Medicaid
OH000000230171OtherANTHEM
OHWI4103871Medicare ID - Type Unspecified