Provider Demographics
NPI:1629804034
Name:STEVENS, CORRIN ELIZABETH (HIS)
Entity type:Individual
Prefix:MS
First Name:CORRIN
Middle Name:ELIZABETH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2631
Mailing Address - Country:US
Mailing Address - Phone:509-736-4005
Mailing Address - Fax:509-737-9525
Practice Address - Street 1:4015 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2631
Practice Address - Country:US
Practice Address - Phone:509-736-4005
Practice Address - Fax:509-737-9525
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA61556333237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist