Provider Demographics
NPI:1720647175
Name:CLAUDIO CORTES, IVELYSSE
Entity Type:Individual
Prefix:
First Name:IVELYSSE
Middle Name:
Last Name:CLAUDIO CORTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 VIVALDI LN
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1411
Mailing Address - Country:US
Mailing Address - Phone:787-447-5110
Mailing Address - Fax:
Practice Address - Street 1:RSU/OFIC OF SPEC EDUC- SPEECH-LANGUAGE DEPARTMENT
Practice Address - Street 2:200 E NORTH AVENUE, ROOM 211
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:443-642-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist