Provider Demographics
NPI:1194253633
Name:VISCOMI, CORINNE ELISSA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:ELISSA
Last Name:VISCOMI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GOLDENS BRIDGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2804
Mailing Address - Country:US
Mailing Address - Phone:914-893-2223
Mailing Address - Fax:
Practice Address - Street 1:190 GOLDENS BRIDGE RD STE 5
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536
Practice Address - Country:US
Practice Address - Phone:914-893-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026487-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist