Provider Demographics
NPI:1336587187
Name:TILSON, CORBIN W (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORBIN
Middle Name:W
Last Name:TILSON
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 1:4009 WHEAT CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7067
Mailing Address - Country:US
Mailing Address - Phone:804-546-8780
Mailing Address - Fax:
Practice Address - Street 1:4009 WHEAT CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7067
Practice Address - Country:US
Practice Address - Phone:804-546-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist