Provider Demographics
NPI:1780703280
Name:ACKERMAN, COREY (MA)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 AVENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3103
Mailing Address - Country:US
Mailing Address - Phone:323-578-7267
Mailing Address - Fax:
Practice Address - Street 1:2966 AVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-3103
Practice Address - Country:US
Practice Address - Phone:323-578-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1879231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist