Provider Demographics
NPI:1265938823
Name:CORINNE VISCOMI, SPEECH-LANGUAGE PATHOLOGIST PLLC
Entity type:Organization
Organization Name:CORINNE VISCOMI, SPEECH-LANGUAGE PATHOLOGIST PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:ELISSA
Authorized Official - Last Name:VISCOMI
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:914-439-1241
Mailing Address - Street 1:190 GOLDENS BRIDGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2804
Mailing Address - Country:US
Mailing Address - Phone:914-439-1241
Mailing Address - Fax:
Practice Address - Street 1:190 GOLDENS BRIDGE RD STE 5
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536
Practice Address - Country:US
Practice Address - Phone:914-893-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026487-1252Y00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty