Provider Demographics
NPI:1669936837
Name:CORBITT, KENDALL CORBITT NIKEA (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KENDALL CORBITT
Middle Name:NIKEA
Last Name:CORBITT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2041 COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35752-6820
Mailing Address - Country:US
Mailing Address - Phone:256-259-9500
Mailing Address - Fax:
Practice Address - Street 1:305 W PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4360
Practice Address - Country:US
Practice Address - Phone:256-609-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4152235Z00000X
AL14072922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4152OtherALABAMA BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY (ABESPA)
AL14072922OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)