Provider Demographics
NPI:1861621518
Name:STOGDILL, CORINNE D (MA)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:D
Last Name:STOGDILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15546 STATE ROAD 23
Mailing Address - Street 2:PO BOX 336
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9646
Mailing Address - Country:US
Mailing Address - Phone:574-277-3449
Mailing Address - Fax:
Practice Address - Street 1:15546 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9646
Practice Address - Country:US
Practice Address - Phone:574-277-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001297A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist