Provider Demographics
NPI:1902061294
Name:CORBIN, MARY KAY (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:CENTER FOR DISABILITIES AND DEVELOPMENT
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-353-6124
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR OFFICE 333A
Practice Address - Street 2:UNIVERSITY OF IOWA CHILDREN'S HOPITAL
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-353-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03129171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator