Provider Demographics
NPI:1790575314
Name:CORRELL, KARISSA
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:CORRELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:CORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5840 VIA DEL BISONTE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5840 VIA DEL BISONTE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3579
Practice Address - Country:US
Practice Address - Phone:559-977-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist