Provider Demographics
NPI:1770729477
Name:MCCANN, CORRIN (SLP)
Entity type:Individual
Prefix:
First Name:CORRIN
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CORRIN
Other - Middle Name:
Other - Last Name:RADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:490 HIGHWAY 96 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1961
Mailing Address - Country:US
Mailing Address - Phone:651-451-3016
Mailing Address - Fax:651-481-7040
Practice Address - Street 1:490 HIGHWAY 96 W
Practice Address - Street 2:SUITE 300
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1961
Practice Address - Country:US
Practice Address - Phone:651-451-3016
Practice Address - Fax:651-481-7040
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist