Provider Demographics
NPI:1588878078
Name:KOLE, CORRINE LYNETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:LYNETTE
Last Name:KOLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S MANZANITA AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5139
Mailing Address - Country:US
Mailing Address - Phone:928-925-4818
Mailing Address - Fax:
Practice Address - Street 1:300 S GRANITE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4253
Practice Address - Country:US
Practice Address - Phone:928-717-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60105823235Z00000X
CA17180235Z00000X, 235Z00000X
AZ0027235Z00000X
SC6521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist