Provider Demographics
NPI:1831757319
Name:GAMBAL, CORINA RAE
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:RAE
Last Name:GAMBAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LAVENDER RD
Mailing Address - Street 2:
Mailing Address - City:MAX MEADOWS
Mailing Address - State:VA
Mailing Address - Zip Code:24360-3310
Mailing Address - Country:US
Mailing Address - Phone:804-516-6217
Mailing Address - Fax:
Practice Address - Street 1:1113 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-3891
Practice Address - Country:US
Practice Address - Phone:276-728-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010318235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202010318OtherVA BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY