Provider Demographics
NPI:1881962959
Name:CORNICK, CRAIG MARVIN (SLP)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MARVIN
Last Name:CORNICK
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WEST AGENCY, SUITE 1
Mailing Address - Street 2:UNIVERSAL THERAPY GROUP
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1702
Mailing Address - Country:US
Mailing Address - Phone:319-752-7899
Mailing Address - Fax:
Practice Address - Street 1:411 WEST AGENCY SUITE 1
Practice Address - Street 2:UNIVERSAL THERAPY GROUP
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1702
Practice Address - Country:US
Practice Address - Phone:319-752-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist