Provider Demographics
NPI:1124072319
Name:STINE, CORRIN A (MA)
Entity type:Individual
Prefix:
First Name:CORRIN
Middle Name:A
Last Name:STINE
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 1:440 S LINCOLN AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8916
Mailing Address - Country:US
Mailing Address - Phone:970-879-4327
Mailing Address - Fax:970-879-7783
Practice Address - Street 1:440 S LINCOLN AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8916
Practice Address - Country:US
Practice Address - Phone:970-879-4327
Practice Address - Fax:970-879-7783
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO227231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC806023Medicare PIN