Provider Demographics
NPI:1902147648
Name:CORBIN, ALICIA SANDERS (MED CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:SANDERS
Last Name:CORBIN
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2953
Mailing Address - Country:US
Mailing Address - Phone:904-735-7446
Mailing Address - Fax:
Practice Address - Street 1:423 6TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5727
Practice Address - Country:US
Practice Address - Phone:904-735-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist