Provider Demographics
NPI:1831490036
Name:DEWITT, CORRINE M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:M
Last Name:DEWITT
Suffix:
Gender:F
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 1:3419 EDDY LN
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-4112
Mailing Address - Country:US
Mailing Address - Phone:715-835-3140
Mailing Address - Fax:
Practice Address - Street 1:3419 EDDY LN
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-4112
Practice Address - Country:US
Practice Address - Phone:715-835-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2718-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist