Provider Demographics
NPI:1780960112
Name:LADUC, KORRINE ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KORRINE
Middle Name:ANN
Last Name:LADUC
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 S MAIN ST
Mailing Address - Street 2:APT D206
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-8707
Mailing Address - Country:US
Mailing Address - Phone:315-256-7796
Mailing Address - Fax:
Practice Address - Street 1:2 BUCCANEER BLVD
Practice Address - Street 2:OSWEGO HIGH SCHOOL
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1951
Practice Address - Country:US
Practice Address - Phone:315-341-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017627-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist