Provider Demographics
NPI:1366555278
Name:SPEED, CORRINIA Y (MCD-CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:CORRINIA
Middle Name:Y
Last Name:SPEED
Suffix:
Gender:F
Credentials:MCD-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:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77549-1450
Mailing Address - Country:US
Mailing Address - Phone:281-992-5300
Mailing Address - Fax:281-992-5302
Practice Address - Street 1:820 S FRIENDSWOOD DR
Practice Address - Street 2:STE., 203-C
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4591
Practice Address - Country:US
Practice Address - Phone:281-992-5300
Practice Address - Fax:281-992-5302
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179793801Medicaid