Provider Demographics
NPI:1225864465
Name:LYONS, CORIN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CORIN
Middle Name:
Last Name:LYONS
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 1:4917 PENNSBURY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-6811
Mailing Address - Country:US
Mailing Address - Phone:813-731-3052
Mailing Address - Fax:
Practice Address - Street 1:18600 HIGHWOODS PRESERVE PKWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1719
Practice Address - Country:US
Practice Address - Phone:813-375-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist