Provider Demographics
NPI:1144318197
Name:LAVIN, CORINA PEREZ (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:PEREZ
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 REDSKIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3380
Mailing Address - Country:US
Mailing Address - Phone:956-377-5155
Mailing Address - Fax:956-377-5123
Practice Address - Street 1:2010 REDSKIN AVE STE A
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3380
Practice Address - Country:US
Practice Address - Phone:956-377-5155
Practice Address - Fax:956-377-5123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181333901Medicaid
TX8T6342OtherBCBS PROVIDER #