Provider Demographics
NPI:1104250877
Name:MASH, CORI ELIZABETH (SLP)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:ELIZABETH
Last Name:MASH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7850
Mailing Address - Country:US
Mailing Address - Phone:252-758-7048
Mailing Address - Fax:252-215-5614
Practice Address - Street 1:1330 E ARLINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7850
Practice Address - Country:US
Practice Address - Phone:252-758-7048
Practice Address - Fax:252-215-5614
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14045818OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION (ASHA)