Provider Demographics
NPI:1750403523
Name:CORBIN-LEWIS, KIM (PHD)
Entity type:Individual
Prefix:PROF
First Name:KIM
Middle Name:
Last Name:CORBIN-LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OLD MAIN HL
Mailing Address - Street 2:DEPT OF COMMUNICATIVE DISORDERS & DEAF EDUCATION
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-1000
Mailing Address - Country:US
Mailing Address - Phone:435-797-1302
Mailing Address - Fax:435-797-0221
Practice Address - Street 1:1000 OLD MAIN HL
Practice Address - Street 2:DEPT OF COMMUNICATIVE DISORDERS & DEAF EDUCATION
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-1000
Practice Address - Country:US
Practice Address - Phone:435-797-1302
Practice Address - Fax:435-797-0221
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111768-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist